Help me understand my fibroids
Dear Dr Mitchell,
I’m a 40-year-old newly-wed and I need some advice. I need to know the impact of submucous fibroids. I just found out that I have a reappearance of fibroids after having done a myo surgery three years ago. My husband and I are trying to have a baby, but we were told that this 1.3cm submucous fibroid could prevent conception or cause menorrhagia. Do I really need to do surgery to remove this fibroid before conceiving?
Uterine fibroids are the most common solid tumour (growth in women, seen in 25-50 per cent of women.) Fibroids may be subserosal (outside of the walls of the uterus), intramural (within the wall) or submucosal (within the cavity of the uterus). In most cases fibroids cause no symptoms and need no treatment. Fibroids that cause symptoms such as heavy periods, painful periods or pelvic pressure will need treatment, which may be in the form of medical or surgical treatment. Medical treatment may be used to stop the periods, reduce the menstrual blood loss, or reduce pain associated with the periods. Surgical treatment is usually in the form of myomectomy, hysterectomy or uterine artery embolisation. Myomectomy may be done in the usual way through a large abdominal incision or using the laparoscope or hysteroscope. Uterine artery embolisation is not appropriate for patients who desire subsequent fertility because of the complications associated with the procedure.
The type of treatment will be determined by the size, position of the fibroids and the desire for future fertility. Submucous fibroids (inside the cavity of the uterus) tend to cause heavy periods. These fibroids may interfere with implantation of a fertilised egg if the placenta implants itself over the fibroid.
This may cause a small increase in the chance of a spontaneous abortion. This tends to be more common with large submucous fibroids. A fibroid of 1.3cm is extremely small and should cause no significant complication in pregnancy. Submucous fibroids do not interfere with your ability to become pregnant unless they are large and block the tube where it enters into the uterus. In general, fibroids only contribute to infertility in only 15 per cent of cases.
Submucous fibroids may be removed by hysteroscopic resection. This procedure utilises a special instrument called a hysteroscope which is inserted via the vagina through the cervix and allows for the removal of fibroids in the cavity of the uterus. This avoids a cut on the abdomen, has fewer complications with damage to the tubes from adhesions and the recovery time is significantly less since this can be done as an outpatient procedure with prompt return to work.
However, if other fibroids are present in the wall of the uterus or on the outside of the uterus, then this procedure will not be appropriate. The disadvantage of doing unnecessary surgery to remove fibroids especially when they are small and cause no symptoms, is that the procedure may cause scarring in the cavity of the uterus, causing the walls to stick together and resulting in subsequent infertility or recurrent pregnancy losses. In some cases scarring will result in total absence of the menstrual periods because of damage to the lining of the uterus. Repeated abdominal surgery may also cause scarring of the Fallopian tubes resulting in blockage and subsequent infertility or increase risk for an ectopic pregnancy.
In most patients fibroids will regrow within five years of removal, so it is best that you actively try for conception as soon as possible. At the age of 40 years your ability to conceive will decrease as the years go by, so your best chance is now. You should start taking daily folic acid supplementation to reduce your chance of birth defects involving the spinal cord and brain, and continue this through the first 14 weeks of pregnancy. Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions and comments via email to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.
