About Us: Articles
Uterine Fibroids, Their Affects on Fertility, Pregnancy and Beyond
By Kelly Burgess
January 2008
Robin Ryan of Trumbull, Conn., had never heard of uterine fibroids when she was diagnosed with them during a routine gynecological examination. Since she was asymptomatic and was planning to have children in the future, Ryan and her doctor decided to just watch and wait. In 2002, she had no problem conceiving. The pregnancy wasn't as simple.
"I had an awful pregnancy because of the fibroids," Ryan says. "I was hospitalized twice, once at seven months because of early labor and had to be on bed rest for two months until the baby was born. My doctor said that the combined size of the baby at seven months gestation and the fibroids 'tricked' my body into thinking it was time to give birth."
Later, Ryan underwent a myomectomy to have her fibroids removed. She and her husband do want another child, but aren't sure if her ability to conceive will be affected by the procedure.
Dr. Bruce McLucas, assistant clinical professor in the department of obstetrics and gynecology at UCLA, says Ryan's experience is typical, in that uterine fibroids aren't usually an issue of initial fertility, but rather one of miscarriage and preterm labor. But the available treatments are a roll of the dice as far as fertility is concerned.
Fibroid Facts
Uterine fibroids are benign growths of the muscle wall of the uterus. Most likely genetic in origin, they are extremely common and usually symptom free. According to the National Institutes of Health, as many as 77 percent of women in the United States have fibroid growths. Of that number, it is estimated that 25 percent experience symptoms.
These symptoms may include heavy periods, bleeding between periods, pelvic pain or "fullness," abdominal swelling and reproductive problems, including infertility and multiple miscarriages. Not surprisingly, uterine fibroids can make a woman's life miserable. In fact, the NIH notes that "uterine fibroids not only affect the women who have them, they also impact the partners, spouses and families of these women, sometimes to a great degree. Despite the fact that they may affect one-quarter of all the women in the U.S., fibroids continue to baffle doctors and scientists."
The reason they are "baffled" is because, while there are several treatments for uterine fibroids, no one treatment works for every woman. Also, some women respond wonderfully to at least one treatment, while others may never find relief.
Dr. William H. Parker, clinical professor of the department of obstetrics and gynecology at the UCLA School of Medicine, and author of A Gynecologist's Second Opinion: The Questions & Answers You Need to Take Charge of Your Health (Plume, 2002), says fibroids are probably responsible for more unnecessary gynecologic surgery than any other condition. "There are several options now available for fibroid treatment and a woman needs to educate herself," Dr. Parker says. "Hysterectomy was the only treatment for a long time and it was what doctors were trained to do. Our modern problem is that doctors are often too busy to keep up with new medical developments. Newer options are less invasive and have fewer long-term effects than hysterectomy."
Fibroid Treatment Options
Choosing the right treatment option depends upon the age of the woman, the severity of symptoms, the woman's desire to have children and her comfort level regarding surgery. The following is an overview of current options, from least to most invasive:
Watch and Wait: This is the course of action usually recommended when fibroids are found during a routine exam and are not yet causing bothersome symptoms, or in cases where the woan still feels the symptoms are bearable and is worried about other treatments impacting her fertility or overall health.
Medication: While medications can't prevent or permanently shrink fibroids, some can help reduce symptoms. Low-dose birth control pills reduce periods from 13 a year to four. This is significant, Dr. Parker says, in women who have such heavy bleeding that they're confined to their homes for days. Other medication options are Lupron and Synarel, which work by temporarily shutting off the ovaries' ability to make estrogen and progesterone so that menstrual periods cease. Because of the risks of long-term use, these two medications are temporary solutions, used to ease a woman's symptoms prior to menopause, to prepare her for surgery or to deal with anemia.
Uterine Fibroid Embolization: Barely a decade old, this non-surgical procedure is generally performed by an interventional radiologist. A small incision is made in the groin directly over the artery carrying blood to the leg. A catheter is then guided into the blood vessels to the uterus and blood flow is blocked with small plastic particles. The fibroids begin to die immediately and continue to shrink for three to six months. Dr. McLucas was one of the doctors that introduced this procedure to the United States and is one of the few gynecologists who performs it himself.
"Myomectomy was the traditional therapy for someone who wanted to preserve her uterus either for fertility or just because [she] wanted to keep [her] uterus," Dr. McLucas says. "From my point of view, UFE is a much more elegant way to treat fibroids because the uterus is left intact."
According to Dr. McLucas, studies show that UFE works nine times out of 10, and seems to leave a good prognosis for long-term fertility. At least 30 percent, and maybe as many of 50 percent, of women who want to have children are able to do so after UFE.
Natale Hunter, a patient of Dr. McLucas, was the first woman to have the procedure in the United States. It was performed in 1993 by Dr. Scott Goodwin, an interventional radiologist, in consult with Dr. McLucas. Six years later, she gave birth to her first child. At the time, she didn't realize she was such a pioneer.
"When I was consulting with Drs. McLucas and Goodwin, I thought I was going to have a myomectomy," Goodwin says. "I just begged them to please do whatever it took so I could still have children. They decided I was a good candidate for this procedure, and they obviously made a good decision."
Myomectomy: Myomectomy is a surgical procedure in which the fibroids are removed and reconstruction and repair of the uterus is undertaken. It can be done either abdominally or vaginally, depending upon the circumstances. The outcome is generally good, and fertility is maintained in an estimated 50 percent of all cases. There are some caveats. Recovery can be difficult and painful. Scar tissue may impact fertility and cause its own problems. And, as Dr. McLucas points out, the fibroids can grow back, and do in up to one-third of all women. It's probably not the best choice for younger women.
Hysterectomy: Removing the uterus certainly removes the problem but often leads to other issues. Both Drs. McLucas and Parker agree that this should be a treatment of last resort.
The bottom line is that not all treatments work for all women. A women needs to be informed and to work with her doctor to decide on her best course of treatment. Also, regular exams are important to catch fibroids while they're still small.
"One thing women need to bear in mind is that regardless of the method of treatment chosen, it's better to have it done earlier rather than later," Dr. McLucas says. "If we start with a uterus that's the size of a six-month pregnancy and get it down to four months it's still big."