What Size Fibroids Should Be Removed
Larger fibroids are associated with lower chances of getting pregnant and carrying a full-term pregnancy, but the jurys still out on what size fibroids should be removed.
Whether fibroids should be removed before pregnancy depends on many factors, including location, size, and number of fibroids, as well as your past and current health history.
What Causes Uterine Fibroids To Grow
No one really knows what causes uterine fibroids. Genetics, hormones, diet, and stress or a combination of things may play a part.
Its likely that fibroids are controlled by hormones, like estrogen and progesterone. They grow when hormone levels are high , and stop growing or shrink when people use anti-hormone medication or go through menopause.
How Uterine Fibroids Affect Fertility
If you do suffer from fibroids and are trying to conceive you might be worried about your ability to become pregnant naturally. Usually, the fibroids themselves dont cause any issues when it comes to fertility, but it does occur in some cases.
If you are having problems getting pregnant and know that you suffer from fibroids you should discuss your condition with your doctor. Some studies have shown that 5-10% of women suffering from infertility have fibroids.
Some fibroids, especially submucosal fibroids, can cause miscarriages and infertility depending on location, size, and number of masses. It is important to have a full fertility work up to verify that the fibroids are causing the infertility before treating.
Some treatments of fibroids can drastically affect your ability to get pregnant. Many women see their fibroid symptoms subside with the use of oral contraceptives or IUDs, but these types of measures prevent pregnancy while using them.
Hysterectomy and endometrial ablation are two possible treatments for extreme or recurring cases of fibroids and would mean you could never get pregnant. Therefore it is important to take into consideration your family planning when deciding treatment options.
Treating Fibroids For Fertility
It is unclear if removing fibroids improves fertility or prevents pregnancy complications. Some studies show positive outcomes after these procedures, but more research is needed.
Uterine artery embolization is a procedure that involves threading a thin tube into the blood vessels that supply blood to the fibroid. Plastic or gel particles are injected into the blood vessels to block blood supply to the fibroid, causing it to shrink.
While pregnancy is possible in some people after UAE, it is not recommended for people who desire future pregnancy. Research shows that chances of pregnancy are lower and the rate of miscarriage can be as high as 56% after the procedure.
Talk with your OB-GYN or RE about your fibroid treatment options if you are trying to conceive now or planning to in the future. There are also natural fibroid treatments that you may want to consider.
Can Fibroids Prevent You From Getting Pregnant
Its natural to feel concerned if you suspect you have uterine fibroids. First off, know youre not alone. As many as 1 in 4 women have fibroids during their reproductive years, and the growths, which are usually not cancerous, are even more common among African American women .
Even though theyre not normally malignant, fibroids may affect your fertility in multiple ways. Between 5-10% of infertile women have fibroids. And fibroids with specific characteristics are more closely linked to infertility and pregnancy complications .
Whether you have a sneaking suspicion you have a fibroid or youve been diagnosed by a practitioner, heres what you need to know about these growths and your fertility. Well also break down whether fibroids can harm your growing baby once youre pregnant and if its possible to get rid of them naturally.
What are the symptoms of fibroids?
About half of fibroids are symptomless, meaning its possible to have one without any sign of it. However, if you suspect you have fibroids, be on the lookout for the following signs :
- Longer, heavier periods
- Frequent urination or difficulty urinating
- Constipation, pain, or trouble with bowel movements
Some women with fibroids have so much bleeding they become anemic. Infertility or miscarriage also may be warning signs of fibroids, although the good news is most women with fibroids are fertile and can conceive even with fibroids .
Can fibroids prevent pregnancy?
How are fibroids treated?
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How Do Fibroids Cause Infertility
Uterine fibroids can affect your fertility in several different ways based on how their size and location changes your uterus, cervix or fallopian tubes.
- Fallopian tubes can be blocked by fibroids which makes it challenging or impossible for a fertilized egg to implant.
- Changes in the shape of the cervix can affect the number of sperm that can enter the uterus.
- Changes in the shape of the uterus can interfere with the movement of the sperm or embryo.
- Fibroids can impact the thickness of the uterine lining
- Blood flow to the uterine cavity can also be affected. This can decrease the ability of an embryo to implant in the uterine wall or to develop.
How Fibroids Can Affect Your Fertility
Those non-cancerous tumors made up of cells and muscle known as fibroids can be a quirky lot. Many women with uterine fibroids have no symptoms whatsoever, and some never even know they have them. Others have painful and heavy periods and struggle with discomfort. With all these disparate situations you may be wondering if and how fibroids can affect your fertility.
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What Fibroid Treatments Should I Choose To Help My Fertility
Thankfully, you have many treatment options when it comes to fibroid tumors. Its important to talk to a fibroid specialist about your family goals so you can choose the one thats best for you.
In our Houston fibroid practice, we offer a treatment known as Uterine Fibroid Embolization . It is a minimally-invasive, non-surgical option that shrinks and kills fibroids by cutting off their blood supply. The procedure is performed through a catheter inserted through your arm. Particles are injected to the catheter to block the artery feeding your fibroids. Many women who undergo UFE go on to have healthy pregnancies.
Some women who still want to get pregnant may prefer a myomectomythe surgical removal of your fibroid. If thats the treatment option you select, youll need to give your uterus three to six months of healing time before trying to get pregnant.
One final word of warning, to help you manage your expectations: if youve had six or more fibroids removed surgically, research shows that you have a lower chance of getting pregnant than women with fewer fibroids. Its also important to note that myomectomy may weaken your uterus, so it may be safer to deliver your baby via C-section following this fibroid treatment option.
While this information may seem frightening, its important to remember: pregnancy is possible, with and after fibroids. Stay positive, and be sure to schedule a consultation with our fibroid experts to discuss all your treatment options.
Recurrence And Reintervention Following Myomectomy
Fibroid recurrence has been reported in 15-51% of cases up to five years after myomectomy . This large variability was probably due to ethnic diversity of the study groups, as well as different criteria and methods used to diagnose recurrence. In the past, the probability of a subsequent surgery was thought to be based on the patient’s age during the first myomectomy, but may actually be more affected by parity as the cumulative probability of recurrence is decreased if a woman has children after myomectomy.
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What Increases The Risk Of Getting Fibroids
- Age. Up to 80 percent of women may have fibroids by age 50.
- Family history. If a family member had fibroids, this increases your risk. If your mother had fibroids, your risk of having them is about three times higher than average.
- Ethnic origin. African-American women are more likely to develop fibroids than other ethnicities.
- Obesity. Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
- Eating habits. Eating a lot of red meat increases the risk of fibroids, as does drinking alcohol. Eating lots of vegetables and fruit may reduce your chance of developing fibroids.
Not Having Sex At The Right Time
The right time means during ovulation the 12- to 24-hour period when your ovaries release a mature egg that can be fertilized by sperm. While sex at any time always comes with the potential of getting pregnant, your chances are much, much higher during this small window.
Ovulation generally happens around halfway through your menstrual cycle. But figuring out when that is can sometimes take some detective work, especially if your cycles are irregular. Make sure you understand how to track them, plus ovulation signs to watch for.
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Surgical Treatment For Fibroids
In cases where uterine fibroids are very large or are causing severe symptoms, a hysterectomy may be recommended. However, for women who wish to have children, there are other procedures that leave the uterus in place. These procedures include:
- Myomectomy: A myomectomy is the surgical removal of uterine fibroids while the uterus is left in place. This surgery can be done laparoscopically, with robot assistance, or in a traditional open procedure. If fibroids return, multiple surgeries may be required.
- Resection of submucosal myoma: A submucosal myoma is a fibroid located under the mucosal layer of the uterus that protrudes into the uterine cavity. Sometimes these fibroids can be removed with a procedure called a resection. This procedure can be performed with a hysteroscope. A hysteroscope is a long, thin telescope-like device that is inserted into the vagina into the uterus. This technique is less invasive than open procedures.
You Constantly Have To Pee
If youve noticed that youre peeing more frequently, or just feel the urge to pee more frequently, it might be the result of a fibroid. Because the uterus is located right next to the bladder, a mass growing on the left side of your uterus could very well cause urinary pressure or frequency, says Shirazian.
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Not Waiting Long Enough
Those couples who seem to get pregnant the second they start trying ? Theyre the exception, not the norm. While your first negative pregnancy test can be disappointing, most women rack up a few before finally seeing a plus sign.
At best, the average couple has around a 25 percent chance of getting pregnant during any given cycle. So even though it can be hard, be patient. Its within the realm of normal to take up to a year to get pregnant if youre under 35. Still, if youre concerned about the time its taking you to conceive, its a good idea to see a specialist.
Can Fibroids Affect Pregnancy
Since most fibroids have the ability to alter the shape and size of the uterus, as well as being able to grow inside the uterus and along the outer wall, many researchers feel that they can affect conception and pregnancy. However, it has also been shown that removing the fibroids can improve fertility rates up to 70 percent. Subserosal fibroids do not affect fertility.
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When To Seek Help If Youre Having Trouble Getting Pregnant
Theres no downside to reaching out to your doctor any time you or your partner have a concern about conceiving. But in general, experts recommend talking to your doctor if youve been actively trying for a full year and are under 35, or if youve been actively trying for six months and are over 35. If youre over 40, its worth talking with your doctor right away.
You should also talk with your doctor if you have a health issue thats known to increase the chances for infertility. These include irregular periods or no periods, periods that are very painful, endometriosis, pelvic inflammatory disease or more than one miscarriage. Your partner should talk with his doctor if he has a history of testicular trauma, hernia surgery, chemotherapy or infertility issues with a previous partner.
Fetal Risks Related To Fibroids
In general, risk to the growing baby is low. If you have large or multiple fibroids, we’ll watch closely for a few potential concerns:
- Abnormal placenta: Fibroids have been associated with placenta previa and placental abruption . Your doctor can use ultrasound to check the placenta during pregnancy.
- Fibroid growth: Research suggests that approximately two thirds of fibroids will grow or shrink during pregnancy. If growth occurs, it’s typically during the first trimester. Your Ob/Gyn may check the size of your fibroids via ultrasound to monitor changes and evaluate the growth of your baby. To date, research has not shown an absolute correlation between fibroids and fetal growth restriction.
- Breech position: If your fibroids limit space in the uterus, your baby may be breech bottom down instead of head down. Using ultrasound and a physical exam, we monitor the baby’s position as you get closer to your due date. If your baby is not head down your doctor might recommend cesarean section delivery.
- Preterm delivery: Significant fibroid burden may stress the uterus, leading to preterm contractions or premature rupture of membranes and subsequent delivery. It is important to contact your Ob/Gyn if you think you may be in labor or leaking fluid.
Second And Third Trimesters
As your uterus expands to make room for your baby, it can push against your fibroids. This can cause a number of issues during your pregnancy:
- Pain. This is the most common symptom of fibroids, especially if theyâre large. Sometimes, fibroids twist, which can cause cramping and discomfort. Other times, the fibroid outgrows its blood supply, turns red and dies. This process, called âred degeneration,â can cause severe stomach pains. In some cases, it can lead to miscarriage. Over-the-counter medicines like acetaminophen can ease your pain. But avoid ibuprofen early in your pregnancy because it may cause problems with gestation and also in your third trimester. It could cause you to miscarry, reduce the amount of amniotic fluid or cause hearts problems in your baby.
- Placental abruption. Ongoing studies seem to show that pregnant women with fibroids have a much greater chance of placental abruption than women without fibroids. That means your placenta tears away from the wall of your uterus before your baby is delivered. Itâs very serious because your baby wonât get enough oxygen and you can have heavy bleeding. You could go into shock.
- Preterm delivery. If you have fibroids, youâre more likely to deliver preterm — meaning your baby is born before 37 weeks of pregnancy — than women without fibroids.
Will Fibroids Affect My Fertility
Depending on the size and location of your fibroids, the tumors can block sperm from reaching and fertilizing one of your eggs. Fibroids can also make it more difficult for a fertilized embryo to implant in your uterus. And, if you do become pregnant, fibroids may impact fetal development if they are located in a spot where your baby should be growing. For these reasons, you may want to treat fibroids before becoming pregnant. But your doctor can better advise you regarding fibroids and your fertility options.
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What Is A Uterine Fibroid
A fibroid is a benign tumor . The exact cause of uterine fibroids is unknownexperts theorize that genes or hormones might have something to do with their development)but we do know that they dont typically indicate a cancer risk or evolve into cancer, so dont let the word tumor freak you out. Fibroids are really common, and for most women, theyre NBD. The size and location of the tumor determines whether youll have any symptoms at all.
Symptoms Of Uterine Fibroids
Most women with fibroids experience no symptoms and may not even realize they have fibroids. However, about 30% of fibroids are symptomatic.
The following are the most common symptoms found:
- Heavy menstrual bleeding and prolonged menstrual period
- Bleeding/spotting in between menstruation
- Constipation and painful bowel movements.
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Problems During The First Trimester
Most fibroids donât grow while youâre pregnant, but if it happens it most likely will be during your first 3 months . Thatâs because fibroids need a hormone called estrogen to grow. Your body produces more of it when youâre pregnant.
The primary problems that could occur are:
- Bleeding and pain. In a study of more than 4,500 women, researchers found that 11% of the women who had fibroids also had bleeding, and 59% had just pain. But 30% of the women had both bleeding and pain during their first trimester.
- Miscarriage. Women with fibroids are much more likely to miscarry during early pregnancy than women without them . And if you have multiple or very larg fibroids, your chances go up even more.
How Fibroids Affect Fertility And Pregnancy
If youre struggling to conceive then one reason could be that you might have fibroids. These are tumors or lumps which can occur singly or in clusters within the wall of the uterus.
Fortunately, they are almost always benign but unfortunately, they can cause havoc with fertility and pregnancy.
Fibroids are extremely common in fact, its estimated that as many as 77% of women of child-bearing age could have fibroids and not know. They can be as small as 1 inch across to as large as 8 inches and can vary in size.
To put this in perspective, a uterus is normally around 4 inches in diameter, so its hardly surprising that a large fibroid could make your belly swell and cause discomfort.
How are fibroids detected?
More often than not, fibroids are found accidentally during a routine pelvic examination when they are sufficiently big for your doctor to notice irregularities in the shape of your uterus.
Smaller fibroids, on the other hand, can easily go undetected especially if you havent noticed any symptoms.
If its suspected that you have fibroids, this is usually confirmed with an ultrasound, MRI scan, or a hysteroscopy procedure.
But what about the types of fibroids?
There is more than one type of fibroid depending upon where its positioned in or on the uterus.
So what causes fibroids?
In reality, no one really knows, but its thought to be related to the levels of hormones produced by the womans ovaries.
What about the symptoms?
How can fibroids affect fertility?
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