Fibroids

Uterine fibroids are benign growths of the uterus muscle tissue. They are extraordinarily common. It is said that one woman in three has a fibroid of some sort in her uterus. In most cases they are extremely small and are of little, if any, significance. Fibroids will tend to gradually grow in size throughout the reproductive years of a woman's life, although the rate of growth is extraordinarily variable. At the menopause, a fibroid would normally cease growing and may indeed gradually shrink in size once again, by as much as 50%.

Fibroids are most commonly associated with heavy periods, pelvic pain, and abdominal swelling. They may also be related to fertility problems, however.

The presence of a fibroid, in itself, is certainly not an automatic explanation for fertility problems. There is considerable controversy about the role that fibroids may play in causing infertility. The size and position of the fibroid is the key factor. Very large fibroids (greater than 5 cm) are more likely to affect fertility, especially if they are growing deep in the wall of the uterus muscle. Fibroids that have grown into the cavity of the uterus and have begun to distort the shape of the uterine cavity are also widely regarded as likely to impaired fertility, even if they are small. I would normally recommend that you give serious consideration to removing such fibroids.

The difficulty with fibroids is that we have no simple way of removing these tumours. No medicines can do this. Surgery is the only reliable technique that can remove the fibroid, and preserve your fertility, at the same time. Even in skilled hands, surgery has the risk of damaging the uterus wall or lining. In every case, I have to “weigh up” the potential advantages, and disadvantages, of surgery before a final decision is reached.

Fertility preservation may be a really important issue for any woman who has a fibroid, even if she is not yet ready to contemplate having a family. Remember, uterine fibroids will tend to gradually increase size as the years progress, right up until a woman reaches the menopause. It is often much easier and less traumatic to remove a fibroid when it is smaller. A woman in her 20s, for example, who has a large fibroid, or one growing into the uterus cavity, may well wish to consider having this removed by a specialist trained in infertility medicine to ensure that this does not become a greater problem by the time she is ready to start a family. For many women the decision will be easy anyway. She may well have other symptoms due to her fibroid, such as heavy periods and/or pain. It is a much more difficult decision for the woman who is completely free of symptoms!