Fibroids and fertility
Fibroids are benign growths which are common and do not necessarily affect conception or pregnancy, but it can be important to be aware of them.
Up to 40 per cent of women have some level of fibroid growth in their uterus, but these are not always noticed and can go undetected for years if they are not causing any discomfort.
What is a fibroid and how do you know if you have one?
Women may go to their GPs complaining of heavy bleeding during periods or pain during sex, or of pain in their pelvis. Fibroids can cause all of these and, depending on the severity of the growths or the suffering, the GP may suggest treatment to remove them, or a 'watch-and 'wait policy. They may also be detected by a GP during a routine gynaecological examination.
Fibroids usually grow on or near the uterus but can develop on other smooth muscles in the body. Some are tiny, but others can grow as big as a grapefruit. There might be one fibroid or a cluster of them.
As well as pain or bleeding, other symptoms include back pain or excessive need to urinate. These are caused when a large fibroid is putting pressure on another part of the lower body.
There does appear to be a genetic predisposition to fibroids.
How might fibroids affect successful conception?
The main reason why fibroids can be a concern before pregnancy, is that in severe cases, the only treatment to completely remove them, is a hysterectomy.
In younger women, if any other course of action is possible then it is preferable as this operation would rule out pregnancy at some point in the future. There are currently come other medications to control fibroids but these can have side effects and you will discuss them fully with your GP before taking anything.
Fibroids can also cause very heavy or irregular periods, which can affect your opportunities to conceive with available eggs, or the presence of a large fibroid could hamper the chances of a fertilized egg successfully implanting in the womb.
Although it is not known exactly what causes some women to develop fibroids, there is a link between hormones and their growth. Because fibroids develop after menstruation in a young female, and rarely grow after menopause, some believe it is down to the levels of oestrogen.
In her book, 'Stay Fertile Longer', Mary Kittel cites an Italian study which found women who ate red meat were more likely to have fibroids than women in their study group who ate more seafood, vegetables and fruit. While it would be wrong to completely rule out the instance of fibroids in say, vegetarians, diet and lifestyle changes that are known to help restore a healthy hormonal balance might be a good idea. You should discuss this with your GP or ask to be referred for further medical advice according to your own personal needs.
Fibroids in pregnancy
If you know you have fibroids before you get pregnant, it is a good idea to discuss them with your GP. In extreme cases, you will need to take medical advice very seriously.
However, if they are not causing you a problem or pain, there is not neccessarily any reason why you cannot have a safe pregnancy.
For example, I did not know I had two small fibroids in my uterus, until I went to have my 12-week scan when I was pregnant with my second child. They must have grown in the three years since my previous pregnancy as they were not seen on previous scans. The fibroids were noted and their position and size were observed. We were advised that they were not particularly something of concern as they were small and not close enough to the entrance of the uterus to neccessarily affect a straightforward vaginal delivery.
I was earmarked for an extra scan at 34 weeks so that, ahead of the birth, the obstetrician could find out if they had grown and if their position was still fine for a vaginal delivery. Sometimes, the hormonal changes of pregnancy can make a fibroid grow more fast, or it can make them get smaller. Happily, in my case, they were smaller and their position was fine.
This is quite common and fibroids should not cause undue worry during pregnancy. Awareness is important and monitoring can help doctors decide what is the safest form of delivery and immediate aftercare (if any is needed) for the mother, once the baby is born.
If you have had surgery for a previous fibroid problem, you should discuss the issue with your doctor before conception, as studies have found that surgery can affect the outcome fo a successful pregnancy and/or birth. It can just mean there is a danger from excessive bleeding, but making all the health bodies aware and through careful monitoring, you and your baby will get the safest care possible.
For more about fibroids in general female health, check out the Women's Health website.
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