What are fibroids and how do they affect fertility and pregnancy?
Uterine fibroids often go unnoticed because they usually do not cause any disturbance and are only discovered during a medical examination such as an ultrasound scan. The majority of them do not limit the chances of becoming pregnant but should be taken into account if you decide to become a mother. It all depends on their number, size, and location. These non-cancerous benign tumors of the uterus are rounded and can measure from a few millimeters to several tens of centimeters. They are usually found in or around the uterus, sometimes in the cervix, and very rarely outside the pelvic cavity. If there are no symptoms, regular monitoring is sufficient, as they usually regress after menopause.
CAUSES OF FIBROIDS
The causes of uterine fibroids are unknown. However, they can be hereditary or enhanced by the secretion of estrogen, progesterone, and growth hormones. Generally speaking, they will continue to grow slowly throughout the period during which a woman’s menstruation is due. They can be so small that a microscope is needed to see them, but they can also grow so large that they occupy the entire uterus and can weigh several kilos.
Risk factors for fibroids include the following:
- Family history of uterine fibroids: the risk of developing a uterine fibroid exceeds 40% for women whose ancestors (mother, grandmother, aunt, or sisters) have themselves declared a fibroid
- Ethnicity: women of African and Afro-American origin are 4 times more likely to have fibroids than Caucasian women
- The beginning of menstruation before the age of 12 years old
- the absence of children
- obesity (high body mass index)
- A diet high in meat and alcohol and low in vitamin D.
TYPES OF FIBROIDS
Depending on their location in the uterus, there are four types of fibroids:
- Submucosal or intracavitary fibroids develop in the uterine cavity. These are the rarest, but also those with the most worrying symptoms. They are really troublesome when conceiving a child and increase the risk of miscarriage
- Intramural fibroids are the most common (70% of cases), they are located in the muscle layer and the uterus wall
- Sub-serous fibroids, implanted outside the uterus and developing in the peritoneal cavity
- pedicled fibroids positioned at the periphery of the uterus and attached by a thin pedicle.
In some cases, uterine fibroids can combine several types of profiles. An intramural fibroid can be partially subserous or submucosal.
SYMPTOMS OF FIBROIDS
Women with uterine fibroids often have no symptoms. However, when is particularly large or located in the uterine cavity, it can cause:
- Over-abundant menstruation with sometimes the passing of blood clots
- The period that can last longer than normal
- Heavy bleeding between period cycles
- Urinary problems: if the fibroid presses on the bladder, it feels as if you have to urinate constantly
- Intestinal problems: the fibroid compressing the rectum can cause constipation
- Pain during sexual intercourse
- Lower stomach and back pain
- Swelling in the lower abdomen
- Repeated miscarriages
- Severe anemia due to blood loss
- During pregnancy, there is a risk of premature delivery.
FIBROIDS AND PREGNANCY
Fibroids do not always pose a problem before and/or during pregnancy. However, in certain cases, depending on their location and sometimes their size, they can have an impact on fertility and/or the evolution of the pregnancy. Among the 4 types of fibroids, it is the submucosal or intracavitary that have a detrimental effect on fertility, as they prevent the implantation of the embryo in the uterine cavity by an “IUD” effect. Regardless of their size, as these fibroids also cause heavy menstruation which can lead to anemia, it is important to correct this anemia before pregnancy because, once pregnant, the mother-to-be is more prone to iron deficiency. For all these reasons, this type of fibroid is usually surgically removed in women who wish to become pregnant.
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