Reproductive Endocrinology and Infertility
Infertility - Fibroids

What are fibroids?

Fibroids, also called myomas or leiomyomas, are fibromuscular tumors of the muscular wall of the uterus. These are very common tumors and occur with increasing frequency with age. The vast majority of fibroids are not malignant. They typically grow slowly and produce increasing symptoms as they enlarge over the years. As a result, they are a common cause of hysterectomy. Fibroids can also be removed without removing the uterus, a procedure called myomectomy.

How are fibroids diagnosed?

An enlarged or irregular uterus is frequently detected at the time of an annual examination. The fibroids are commonly diagnosed before any symptoms have developed. A pelvic ultrasound is frequently used to confirm the presence of fibroids. An ultrasound can also determine the size, location and number of fibroids.

What are the symptoms associated with fibroids?

Large fibroids typically cause pelvic pressure. This can include the feeling of the uterus falling out, urinary frequency and urgency due to pressure on the bladder, or constipation due to pressure on the intestines. Fibroids can also cause irregular vaginal bleeding or heavy menstruation. If a fibroid is deep in the uterus it can disrupt the blood flow to and functional integrity of the uterine lining. Deep fibroids are called submucosal if they lie directly under the uterine lining or intracavitary if they are on a stalk and located within the uterine cavity.

How are fibroids treated?

Small fibroids that are not deep in the uterus and do not cause significant symptoms do not require treatment. Symptomatic fibroids require surgical removal by myomectomy (preservation of uterus) or hysterectomy. Myomectomies can frequently be done through the laparoscope as an outpatient. Large fibroids usually require a larger incision with hospital admission for a few days.

Can fibroids cause infertility?

Fibroids can cause infertility or repetitive miscarriages if they are deep within the uterus and disrupt the normal function of the uterine lining. Large fibroids can block the fallopian tubes. An ultrasound to determine the location of the fibroid(s) and a hysterosalpingogram (x-ray of the uterus and tubes) to evaluate the uterine cavity and determine of the fallopian tubes are open are useful tests to help determine if surgery is needed.