General information
Uterine fibroids, also called fibromyomas, leiomyomas or myomas, are non-cancerous tumours, which can be found in various locations of the uterus, with varying size and severity.
Around 20% of women of reproductive age develop uterine fibroids that can be detected. However, around 70-75% of women may develop fibroids so small that may not be detected [1].
Causes
The reasons why uterine fibroids develop are unclear. Family history however, is a known risk factor for the development of uterine fibroids [2]. Other risk factors include:
- Increased levels of estrogen and progesterone
- Age
- Obesity
- Number of previous pregnancies [3].
Symptoms
Not all women with uterine fibroids present with symptoms. However, symptoms may arise and include:
- Abnormal bleeding, including heavy and painful periods
- Feeling of pressure in the abdomen
- Pain in the abdomen
- In some cases infertility
Fibromas and fertility
Uterine fibroids may affect the ability of a woman to conceive depending on their location [4]. This is because fibroids may interfere with the migration of the egg or the sperm and the implantation of the embryo in the endometrium, the lining of the uterus [5].
Evidence has shown that uterine fibroids are associated with 10% of infertility cases and are the only reason of infertility in 1% to 3% of couples that cannot have children [6].
Uterine fibroids may also affect the outcome of an IVF procedure. Studies have shown that the chance of a successful IVF is reduced in patients with fibroids when compared to patients with no fibroids [7, 8].
Removal of the fibroids prior to IVF treatment increases the chances of IVF success [9-12] and is usually recommended by the gynecologist before the start of the IVF cycle [13].
Fibromas and pregnancy
Uterine fibroids may be detected during pregnancy at the first trimester ultrasound with a rate of around 10% [14].
The presence and severity of symptoms depend on the number of fibroids, their location and size.
The most common symptom is pain in the abdomen, which affects around 15% of pregnant women with uterine fibroids [15]. They are also associated with pregnancy loss and preterm delivery.
Diagnosis
Uterine fibroids can be diagnosed with a pelvic examination and a trans-vaginal ultrasound.
Treatment
Treatment options for uterine fibroids vary and depend on:
- Size and location of fibroids
- Patient’s age
- Patient’s desire to have children
Fibroids can be left untreated or removed with laparoscopy or laparotomy. The last but more radical option is the complete removal of the uterus with hysterectomy.
Laparoscopy
Laparoscopy is a very common procedure and has been used by doctors since 1979 [16].
During laparoscopy three or four incisions are made, which are really small and leave minimal scarring on the abdomen. Together with a visual aid the doctor locates and removes the fibroids [17].
The advantages of laparoscopy when compared with laparotomy, which is an open surgery, are the smaller wound size, shorter hospital stay and recovery time [1].
References
1. Lee CL, Wang CJ. 2009. Laparoscopic Myomectomy. Taiwan J Obstet Gynecol. 48: 335-341.
2. Vikhlyaeva EM, Khodzhaeva ZS, Fantschenko ND. 1995 Familial predisposition to uterine leiomyomas. Int J Gynaecol Obstet. 1995 Nov;51(2):127-31.
3. Okolo S. 2008. Incidence, aetiology and epidemiology of uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2008 Aug;22(4):571-88.
4. Ezzati M, Norian JM, Segars JH. 2009. Management of uterine fi broids in the patient pursuing assisted reproductive technologies. Womens Health (London England) 5:413 – 421.
5. Gambadauro P. 2012 Dealing with uterine fibroids in reproductive medicine. J Obstet Gynaecol. 2012 Apr;32(3):210-6
6. Kolankaya A, Arici A. Myomas and assisted reproductive technologies: when and how to act? Obstet Gynecol Clin North Am. 2006;33:145–52.
7. Farhi J, Ashkenazi J, Feldberg D, Dicker D, Orvieto R, Ben Rafael Z. 1995. Th e eff ects of uterine leiomyomata on in-vitro fertilization treatment. Human Reproduction 10:2576– 2578.
8. Eldar-Geva T, Meagher S, Healy DL, MacLachlan V, Breheny S, Wood C. Eff ect of intramural, subserosal, and submucosal uterine fi broids on the outcome of assisted reproductive technology treatment. Fertility and Sterility 70:687 – 691.
9. Bulletti C, Dez D, Levi Setti P, Cicinelli E, Polli V, Stefanetti M. Myomas, pregnancy outcome, and in vitro fertilization. Ann N Y Acad Sci. 2004;1034:84–92.
10. Narayan R, Rajat, Goswamy K. Treatment of submucous fibroids, and outcome of assisted conception. J Am Assoc Gynecol Laparosc. 1994;1:307–11.
11. Varasteh NN, Neuwirth RS, Levin B, Keltz MD. Pregnancy rates after hysteroscopic polypectomy and myomectomy in infertile women. Obstet Gynecol. 1999;94:168–71.
12. Goldberg J, Pereira L. Pregnancy outcomes following treatment for fibroids: uterine fibroid embolization versus laparoscopic myomectomy. Curr Opin Obstet Gynecol. 2006;18:402–6.
13. Penzias AS. Recurrent IVF failure: other factors. Fertil Steril. 2012 May;97(5):1033-8.
14. Laughlin SK, Baird DD, Savitz DA, Herring AH, Hartmann KE. Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound-screening study. Obstet Gynecol. 2009; 113:630–5.
15. Rice JP, Kay HH, Mahony BS. The clinical significance of uterine leiomyomas in pregnancy. Am J Obstet Gynecol. 1989;160:1212–6.
16. Semm K. New methods of pelviscopy (gynecologic laparoscopy) for myomectomy, ovariectomy, tubectomy and adnectomy. Endoscopy. 1979 May;11(2):85-93.
17. Horng HC, Wen KC, Su WH, Chen CS, Wang PH. Review of myomectomy. Taiwan J Obstet Gynecol. 2012 Mar;51(1):7-11.