Fibroids are muscle tumors of the uterus that are very common in the general population. There are estimates that predict the presence of fibroids in up to 35 percent of women at some point in their lives.
The fibroid, also known as a leiomyoma, arises from a single smooth muscle cell that has lost the proper signaling to stop growing. Over time the muscle tumors get larger and may start to cause problems.
Women may have more that one fibroid, but most fibroids are benign and cause no problems other than the problems caused by their location and size.
Their role in infertility is not clearly understood. There is speculation that the fibroids compress the lining of the uterus (the endometrium), or that they interfere with the blood supply to the endometrium.
Some fibroids are in locations that may cause blockage of the cervix or fallopian tubes. They have also been implicated in preterm labor and early pregnancy loss.
Again, their exact mechanism of infertility is not clear and is likely different depending on the size and location of the tumor.
Diagnosis
There are several ways to determine if fibroids are present. A pelvic exam is a very common way physicians evaluate the uterine size and contour. Ultrasound also reveals abnormalities which may be suggestive of uterine fibroids.
Pelvic CT scanning and MRI are helpful but usually not necessary. Many fibroids are discovered as patients begin their monitoring ultrasounds for controlled ovarian hyperstimulation or in vitro fertilization (IVF) cycles.
Uterine fibroids tend to be more of a problem for reproductive-age women and will usually regress after menopause.
Women with multiple fibroids are likely at higher risk for recurrence after a myomectomy.
Fibroids may occur in tissues outside of the uterus. Ligaments and connective tissues in the pelvis also contain muscle fibers that may give rise to fibroids.
These tumors usually will not cause problems with fertility, though they are often removed for diagnostic purposes as they present as a solid mass.
Treatment
Surgery
The most common method for surgically treating fibroids is myomectomy.
The simple presence of fibroids does not warrant surgery in most cases. Surgery is indicated when the fibroids are causing symptoms such as pelvic pain, low back pain, abnormal bleeding, or are imposing on one's ability to become pregnant or carry a pregnancy.
Patients with a history of infertility or large fibroids may also benefit from surgery. You will need to discuss the impact and implications individually with your physician.
Lupron
Lupron has been used to reduce the size of fibroids and decrease abnormal bleeding associated with fibroids prior to surgery.
There is a common belief among surgeons that this therapy can make the procedure slightly more difficult and may shrink some myomas to the point they are missed at surgery.
The most common use of Lupron, therefore, is to control abnormal bleeding prior to surgery. After discontinuation of the Lupron, the myomas resume their previous volume within several months.
Investigational Therapies
There are several investigational therapies for removing myomas including freezing, morcellating, and embolizing.
Many physicians feel these do not offer a significant advantage to directly removing the fibroid and any smaller myomas that may increase a woman's chances for a recurrence.
