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Uterine fibroma, pregnancy and fertility

Uterine fibroma, pregnancy and fertility

Uterine fibroma is a cell mass that develops in the uterus. The fibroma can develop inside the uterine cavity, on the outside of the uterus or in the thickness of its wall. The fibroma is also called the fibrous tumor, leiomyoma or myoma, but it is not a malignant tumor (cancer). The fibroma should be treated only when it creates problems.

Fibroids are most commonly found in women aged 30-40 years. By the age of 50, 80% of women have uterine fibroids. The fibroids can be as small as a pea or as large as a soccer ball and are almost always benign, regardless of size. The presence of uterine fibroids does not increase the risk of developing cancer.

If a fibroid grows too large or grows outside the uterine wall, it may push the uterus to one side or force it to grow abnormally. This can increase the pressure exerted on the bladder or intestines. On very rare occasions, if a fibroid is too large it can block the opening of the uterus. In this case, a pregnant woman will have to perform a caesarean section.

Why does uterine fibroid appear?

Nobody knows for sure why uterine fibroids appear, but the levels of estrogen appear to play an important role in their growth. When estrogen levels are high due to pregnancy or contraceptive pills, the rate of uterine fibroids increases. After menopause, when the amount of secreted hormones decreases, the fibroids usually shrink or disappear.

Symptoms

The symptomatology can develop slowly in a few years or quickly in a few months. Most patients with uterine fibroids have mild symptoms or are asymptomatic and will never need treatment.

For some patients, fibroma symptomatology becomes a problem. In some cases, the first sign may be the difficulty of a pregnancy.

Symptoms and problems caused by uterine fibroids are:

• abnormal menstrual bleeding; up to 30% of patients have menstrual cycle changes;
• prolonged menstrual cycles that can cause anemia;
• dysmenorrhea;
• bleeding before or after menstruation;
• bleeding between the menses;
• pelvic pain or pressure;
• pain in the abdomen, pelvis or lower back;
• pain in sexual contact;
• distension and abdominal pressure;
• urinary problems;
• frequent urination;
• urinary incontinence;
• kidney block after ureteral block (rare);
• other symptoms;
• difficulty in intestinal transit;
• Infertility - sometimes, fibroids make it difficult to get pregnant;
• problems during pregnancy, such as placenta detachment and preterm labor;
• miscarriage.

Can a uterine fibroid affect fertility?

There is some evidence that uterine fibroids may be a cause of infertility. It is known that fibroma can prevent implantation of the fertilized egg into the uterus, sometimes increasing the risk of spontaneous abortion and making it unlikely to be successful in vitro fertilization.

Surgical removal of the fibroid, called myomectomy, is the only treatment proven to improve the chance of pregnancy. Due to the fact that fibroids can recur, pregnancy is indicated as soon as possible after myomectomy. 60% of women who have myomectomy as a treatment for infertility (and have no other causes of infertility) remain pregnant. Experts argue that myomectomy may reduce the risk of miscarriage in patients with fibroids.

Complications caused by uterine fibroids during pregnancyÂ

Although fibroids tend to increase in size during pregnancy, you are unlikely to have specific symptoms. Some pregnant women have some minor symptoms, especially pelvic pain and some mild bleeding. Most often, however, most pregnant women will not even know they have a uterine fibroid.

Most pregnant women who have uterine fibroids will not have problems with pregnancy either. However, uterine fibroids in pregnancy increase the risk of miscarriage or premature birth. Exceptionally, more serious complications can occur if the fibroid becomes very large.

These complications include:

• postpartum hemorrhage;
• fibroma growth in the birth canal;
• abnormal position of the fetus (sometimes the fibroids grow in the uterus forcing the baby to sit in a strange position);
• the pregnancy stopped from evolution;
• cesarean section.

Treatment of uterine fibroids

Treatment of uterine fibroids during pregnancy

During pregnancy it is advisable not to start treatment for fibroids. Your doctor will monitor your fibroid growth to anticipate any other complications. If you have pain, try lying down or use an ice bag to relieve the pain. You may receive emergency treatment if you start to bleed a lot or have severe pain.

Treatment of fibroids with minimal symptoms or during menopause

In the case of fibroids without or with few symptoms, treatment is not necessary. The specialist will recommend vigilant expectation, with regular gynecological examinations, to check the size and symptoms of the fibroid.

If the patient is near menopause, an option will be expected depending on the severity of the symptoms. After menopause, estrogen and progesterone levels will decrease, which will decrease the majority of fibroids and decrease the symptoms.

Abundant menstruation and pain

Pain or heavy menstruation can come from a bleeding uterine fibroid. However, these may be related to the problems of a simple menstrual cycle or may be the result of other problems.

As the only drug that has proven to reduce fibroids has serious adverse effects, one or both of the following will be used for menstrual pain or heavy menstrual bleeding, the combination of the two increasing their effectiveness:

• Non-steroidal anti-inflammatory drugs: reduce menstrual cramps and menstrual bleeding in many women; however, there is no evidence of a reduction in pain or bleeding caused by fibroids
• oral contraceptives: reduces menstrual bleeding and pain, while preventing pregnancy; however, they do not decrease the size of the fibroid, but they do not increase it.

Supplementary iron therapy and a high iron diet, prevents the appearance of anemia through blood loss.

The use of non-steroidal anti-inflammatory drugs during conception or early pregnancy can cause miscarriage. Patients who want a pregnancy should be advised about therapy with these drugs.

Most fibroids are harmless, do not cause symptoms and shrink after menopause. However, some fibroids are painful, press on other internal organs, bleed and cause anemia or cause pregnancy complications.

In the case of uterine fibroids there are several types of treatment to consider. The fibroid may be surgically removed, the entire uterus may be removed, or the medication may be shrunk. The choice of treatment will be made depending on the severity of the symptoms and the importance of maintaining fertility.

Surgical treatment of uterine fibroids

Surgical treatment can be used to remove the fibroid (myomectomy) or the entire uterus (hysterectomy). Surgical treatment is an option for:

• abundant uterine bleeding and / or anemia after months of treatment with oral contraceptives or non-steroidal anti-inflammatory drugs;
• when the fibroid recurs after menopause;
• the uterus is deformed by fibroids and there is a history of repeated spontaneous abortions;
• the pain or pressure caused by fibroids affects the quality of life;
• if there are urinary or intestinal complications (due to the pressure exerted by fibroids on the bladder, ureter or intestines);
• when there is a possibility of cancer;
• when the fibroid is the probable cause of the difficulty of a pregnancy.

The options of a surgical treatment are:

• myomectomy or removal of the fibroid, as this is the only treatment that improves the chance of becoming pregnant;

• hysterectomy or removal of the uterus entirely, being recommended only to patients who do not want children anymore. Hysterectomy is the only treatment that prevents fibroid recurrence. It improves the quality of life for many women, but can also have long-term side effects, such as pelvic organ prolapse.

Myomectomy or hysterectomy can be performed by one or more small incisions, using laparoscopy, vagina or a large abdominal incision. The method used depends on the case, including the location, size, type of the fibroid and the patient's option to become pregnant or not.

Embolization of the uterine fibroid is a non-surgical option that shrinks or destroys the fibroid, disrupting its blood supply.

For the possibility of a future pregnancy, myomectomy is the surgical treatment option. An abdominal approach myomectomy may be safer than a laparoscopic one - there is limited research into pregnancy safety after a laparoscopic myomectomy.

Abundant, prolonged, painful menstrual cycles caused by fibroids will stop physiologically after the onset of menopause. If the patient is near menopause and the symptoms are tolerable, outpatient treatment should be considered to relieve the symptoms until menopause. Embolization of the uterine fibroid may be a reasonable option, but it presents some risks.

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