Fibroids are benign swellings (also known as tumours) arising from the muscle of the womb. They are exceptionally common in women - indeed post-mortem studies show that most women will develop one or more during their lifetime. There are often more than one and, thankfully, they rarely become malignant. They usually get bigger during a woman's reproductive life (especially during pregnancy) and smaller after the change of life, i.e. the menopause.
What causes fibroids?
They arise in the outer, middle, or inner layers of the wall of the womb. Those that arise in the outside layer are known as subserous because they distend the serous membrane that covers the womb (which is called the peritoneum). These are the ones your gynaecologist will see at laparoscopy.
Those that arise in the middle of the womb are called intramural and may cause pain or heavy bleeding.
Those that arise from the inner layers are called submucous because they stretch the inner mucous layer of the womb (called the endometrium).
Effect of fibroids on fertility
Whether fibroids affect your fertility, and therefore whether you need them removed, depends on the size of the fibroid and where in the uterus, the fibroid is located.
The specific problem with submucous fibroids is that they distort the normal contour of the cavity of the womb into which the embryo is trying to implant itself reducing the chance of getting (or staying) pregnant. This is why we may suggest making the cavity more normal before proceeding with fertility treatment including IVF.
However, if the distortion is minor, the risks associated with surgery (e.g. hemorrhage, infection, scarring in the womb, or rupture of the womb before or during labour) may not be worth incurring.
How are they identified?
While ultrasound is usually used to identify intramural fibroids (i.e. those in the wall of the womb), alternative methods are often used to establish whether the cavity of the womb is normal. These include hysteroscopy, hysterosalpingogram, saline sonography, or hycosy.
How are they treated?
No treatment is needed if they are not malignant or contributing to pain, bleeding, infertility, or recurrent miscarriage. Those on the outside (subserous) or in substance of the muscle of the womb (intramural) are usually treated by laparotomy or laparoscopy. Those protruding into the cavity may be treated by laparotomy but ideally are treated by operative hysteroscopic resection as the latter has less risks associated with it.
If I have surgery and get pregnant, will I need a Cesarean Section (C/S)?
In most cases you will need a C/S although you would need to discuss this with your Obstetrician depending on what type of surgery you have had carried out.
Suspect you have fibroids?
If you suspect you may have fibroids and have been trying to conceive for 12 months (or 6 months if you are over 35 years of age) you should consider booking an appointment with a fertility specialist.
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