Uterine Fibroids and Fertility: What Every Woman Should Know

Fibroids are non-cancerous growths in the muscle of the womb, and they are very common. By the age of 50, most women will have developed at least one. Black women tend to get them earlier, with larger growths and heavier symptoms. It is no surprise, then, that questions about uterine fibroids and fertility come up in almost every gynaecology clinic in Nigeria. The short answer is that it depends on where the fibroid sits.

What fibroids are, and who gets them

Any discussion of uterine fibroids and fertility starts with what a fibroid is. Fibroids are firm, rounded lumps of muscle and fibrous tissue. They may be as small as a pea or as large as a melon, and a woman can have one or many. They depend on the hormones oestrogen and progesterone. Consequently, they grow during the reproductive years and shrink after menopause.

Several factors raise the chance of developing them:

• African ancestry
• A mother or sister with fibroids
• Starting periods at an early age
• Being overweight
• Not having had children
• Being between 30 and 50 years old

Fibroids are almost never cancer. Nevertheless, a lump that grows rapidly, especially after menopause, should be examined promptly.

Do fibroids cause infertility?

The link between uterine fibroids and fertility is often overstated. Most women with fibroids conceive naturally. In fact, fibroids are the main cause of difficulty in only a small minority of couples. Location and size matter most:

• Submucosal fibroids bulge into the cavity of the womb. They are the most likely to prevent implantation and raise the risk of miscarriage.
• Intramural fibroids grow within the wall. Small ones rarely matter, but large ones that distort the cavity may.
• Subserosal fibroids grow on the outer surface. They generally do not affect fertility.

Therefore, a fibroid seen on a scan is not automatically the reason for a delay in conceiving. Ovulation, the fallopian tubes and the partner’s semen should all be checked as well.

How fibroids can interfere with conception

Understanding the mechanism explains why position matters so much in uterine fibroids and fertility. A fibroid may:

• Change the shape of the womb cavity, so that an embryo cannot implant well
• Block the opening of a fallopian tube
• Reduce the blood supply to the lining of the womb
• Alter the normal contractions that help sperm to travel
• Leave less room for a pregnancy to grow, which raises the risk of miscarriage

This is why removing a fibroid that bulges into the cavity improves the chance of pregnancy. By contrast, the benefit of removing fibroids that do not distort the cavity is much less certain. Surgery in that situation should be considered carefully.

Symptoms to look out for

Many women have no symptoms at all. Others notice:

• Heavy or prolonged periods, often with clots
• Tiredness and dizziness from anaemia
• Pelvic pressure or pain
• Frequent urination or constipation
• Visible swelling of the lower abdomen
• Pain during sex

How fibroids are diagnosed

A pelvic ultrasound scan is usually enough. For fertility planning, however, your doctor may also request a saline scan, a camera examination of the womb or an MRI. These show whether the cavity is distorted. Ask the doctor to tell you the number, size and position of each fibroid, since those details guide every later decision.

Uterine fibroids and fertility: treatment options

 

• Watchful waiting. Small fibroids that cause no symptoms and do not distort the cavity need no treatment. You can go ahead and try for a baby.
• Medicines. Tranexamic acid, anti-inflammatory painkillers and iron tablets control bleeding and anaemia. Hormone injections can shrink fibroids for a few months before surgery. However, medicines do not remove fibroids.
• Myomectomy. This operation removes the fibroids and keeps the womb. It is the main choice for women who want children. Submucosal fibroids can often be removed through the cervix with no cuts on the abdomen.
• Uterine artery embolisation. This blocks the blood supply to the fibroids. It is usually not the first choice before pregnancy, because its effect on fertility is less certain.
• Hysterectomy. Removing the womb ends fertility, so it is only for women whose families are complete.

After a myomectomy, doctors usually advise waiting three to six months before trying to conceive. Some women will later need a caesarean delivery, and fibroids can grow back.

Preparing for a myomectomy

If surgery is advised, good preparation makes it safer.

• Treat anaemia first. Iron tablets, and sometimes injections that pause your periods, build up your blood level.

• Have the fibroids mapped. A detailed scan shows the surgeon exactly where each one sits.

• Arrange blood. Fibroid surgery can cause bleeding, so the hospital may ask relatives to donate in advance.

• Ask about the method. Options are open surgery, keyhole surgery and removal through the cervix.

• Understand the risks. These include bleeding, infection and scar tissue inside the abdomen, which can itself affect fertility. Very rarely, the womb has to be removed to control bleeding.

After open surgery, expect two to four days in hospital and four to six weeks of recovery. Before you leave, ask whether the womb cavity was opened. The answer decides whether future babies should be delivered by caesarean section.

Newer treatments

Several newer options now exist. Some tablets block the hormones that feed fibroids and reduce bleeding within weeks, although they are not yet widely stocked. Focused ultrasound treatment, offered in a few Nigerian centres, heats and destroys fibroid tissue without any cuts.

However, information about pregnancy after these treatments is still limited. For women who want children, they are therefore not yet a routine replacement for myomectomy. Discuss the evidence with a gynaecologist before paying for any of them.

Fibroids during pregnancy

Most pregnancies with fibroids go well. Fibroids often grow in early pregnancy and shrink again after delivery. Nevertheless, some women experience pain, premature labour, a baby lying in the breech position or heavier bleeding after delivery. For that reason, attend antenatal care with a doctor and plan to deliver in a hospital.

The truth about herbal “fibroid shrinkers”

Herbal mixtures, womb cleansers and supplements that promise to dissolve fibroids are sold everywhere. However, there is no good evidence that any of them work. Meanwhile, the delay allows fibroids to grow, anaemia to worsen and surgery to become more difficult. Some products also harm the liver and kidneys.

Trying to conceive with fibroids: a practical plan

When you are dealing with uterine fibroids and fertility together, a clear sequence saves time and money:

• Have a scan that records the number, size and position of your fibroids.

• Ask directly whether the womb cavity is distorted.

• Complete the basic checks: ovulation, fallopian tubes and your partner’s semen analysis.

• Correct anaemia and start folic acid.

• If the cavity is normal, try naturally for six to twelve months, depending on your age.

• If the cavity is distorted, or if you have had repeated miscarriages, discuss surgery first.

Age matters in this decision. A woman of 38 has less time to wait than a woman of 28, so the plan should be personal.

When to see a doctor

• Periods that soak a pad every hour or last longer than seven days
• Trying to conceive for 12 months, or six months if you are 35 or older
• Two or more miscarriages
• Rapid swelling of the abdomen or severe pelvic pain

Frequently asked questions

Can fibroids grow back after surgery?

Yes. New fibroids can develop over the following years, which is one reason to try for a baby once you have healed.

Can diet shrink fibroids?

No food has been proven to shrink them. However, a healthy weight and plenty of fruit and vegetables support your general and reproductive health.

Can I deliver vaginally after a myomectomy?

Often, yes. It depends on how deep the surgery went, so your surgeon’s notes are important.

Do fibroids affect IVF?

Fibroids that distort the cavity lower IVF success rates and are usually removed first.

Do fibroids always need treatment?

No. Fibroids that cause no symptoms and do not affect the cavity can simply be monitored.

Final thoughts

The relationship between uterine fibroids and fertility is specific to each woman. A fibroid in one position may be irrelevant, while another needs prompt treatment. Insist on a clear description of your scan, ask how each option affects your chance of pregnancy and avoid delays caused by unproven remedies.

Getting help

Clear information about uterine fibroids and fertility helps you choose treatment with confidence. HubPharm pharmacists can advise on medicines for heavy bleeding and anaemia while you see a gynaecologist. For more, read our guide to gynaecological health or the NHS overview of fibroids.