Understanding Uterine Fibroids. A Comprehensive Guide by Dr. Senai Aksoy

Introduction

Welcome to my website! I am Dr. Senai Aksoy, an expert in gynecology and fertility, and I would like to educate you about a condition that affects many women: uterine fibroids. I am here to provide you with reliable and accurate information about this common condition.

What is a uterine fibroid?

A uterine fibroid, also known as a myoma, is a benign tumor that develops in or around the uterus. Although “tumor” sounds alarming, these growths are usually not cancerous and are made up of muscle cells and fibrous tissue. They can vary in size and location and cause various symptoms.

Common symptoms of fibroids

• Painful menstruation: Increased pain and intensity of menstrual cramps.
• Heavy bleeding: Including longer than normal menstrual periods.
• Pressure: Often felt in the lower abdomen, with constant discomfort.

Localization-related symptoms: -Submucosal: Lies under the lining of the uterus and is often responsible for bleeding and fertility problems. -Intramural: Located within the uterine wall, they are the most common and can grow quite large. -Subserosal: Located on the outer surface of the uterus and can spread on a stalk that appears to hang outside the uterus.

The other effects of fibroids on fertility and pregnancy

Uterine fibroids are more than just benign tumors of the uterus; they can significantly affect fertility and pregnancy. These effects depend greatly on the size, location and number of fibroids. Let’s take a look at how these fibroids can affect fertility and pregnancy outcomes.

Effects on conception

Fibroids can affect fertility in various ways, especially if they are located in the uterine cavity or deform the uterus:

1.Obstruction of the sperm ducts:

• Submucosal and some intramural fibroids in particular can block the fallopian tubes, preventing sperm from reaching the egg.

2.Alteration of the uterine cavity:

• Submucosal fibroids can deform the uterine cavity, making it difficult for an embryo to implant or even early embryonic development.

3.Impaired blood flow in the uterus:

• Fibroids can interfere with the normal flow of blood to the uterine lining, which is crucial for preparing the uterus for embryo implantation.

Effects during pregnancy

Even after conception, fibroids can play a role in how the pregnancy develops:

1. Mechanical complications:

• Increased risk of miscarriage: Fibroids, especially those that deform the uterine cavity, are associated with a higher risk of miscarriage in the first and second trimesters.
• Problems during labor: They can also lead to problems during labor, such as the need for a C-section, abnormal positioning of the baby, or premature labor.

2.Increased risks during pregnancy:

• Placental abruption: Growths can lead to premature detachment of the placenta, a serious condition in which the placenta separates from the uterine wall before birth.
• Intrauterine growth restriction (IUGR): Impaired blood flow caused by fibroids can restrict the supply of nutrients and oxygen to the fetus and hinder its growth.

Treatment and management of fibroids for fertility

The treatment of fibroids related to fertility often requires careful investigation to decide whether surgery is necessary:

Indications for myomectomy in connection with fertility

Myomectomy, the surgical removal of uterine fibroids while sparing the uterus, is often performed to improve fertility in women who wish to have children. This procedure may be particularly indicated when fibroids are associated with symptoms or reproductive problems. The specific indications for this procedure in connection with fertility are explained in more detail below.

Presence of severe symptoms

Tumors can cause various symptoms that significantly impair the quality of life: -Excessively painful menstrual periods (dysmenorrhea) -Heavy menstrual bleeding (menorrhagia), which can lead to anemia -Pressure or pain in the pelvis

If these symptoms are severe and the

if these symptoms are severe and interfere with daily life, a myomectomy may be recommended to relieve them, especially if medical treatments have had no effect.

Submucosal or intramural fibroids that deform the uterine cavity

Submucosal and some large intramural fibroids that deform the uterine cavity can particularly affect fertility by -Blocking the fallopian tubes -Interfering with the implantation of the embryo -Causing recurrent miscarriages

A myomectomy is often necessary to remove these fibroids and restore the normal shape of the uterine cavity, improving the chances of conception and maintaining a pregnancy.

Failure of other treatments

Before a myomectomy is performed, other, less invasive treatments such as hormone supplements (GnRH agonists, progesterone receptor modulators) are often tried. If these treatments do not effectively reduce the size of the fibroid or the symptoms, surgery may be considered.

Planning for Reproductive Assistance

For women considering artificial insemination such as in vitro fertilization (IVF), fibroids, especially those that deform the uterine cavity, can reduce the chances of success. In these cases, a myomectomy may be recommended to: -Increase the chances of embryo implantation -Reduce the risk of miscarriage

Fibroids as a cause of unexplained infertility

In some cases, fibroids may be the only obvious cause of unexplained infertility. A myomectomy may be indicated if: -The woman is under 40 years old -Fibroids are the only obstructions diagnosed after a comprehensive fertility workup -The woman wants to have children naturally or increase her chances with IVF

Rapid growth of fibroids

Rapidly growing fibroids may be a sign that they could become problematic, either by their size or by their impact on the surrounding uterine structures. In these cases, early intervention may be necessary to prevent further complications.

Myomectomy methods

1. open myomectomy (laparotomy): -This method is indicated for large fibroids or if several fibroids need to be removed. -It is more invasive and requires an incision in the abdomen.

2. laparoscopic myomectomy: -It is less invasive and is performed for smaller and fewer fibroids. -It requires small incisions and the use of cameras and special instruments.

3. hysteroscopic myomectomy: -Mainly for submucosal fibroids. -A hysteroscope is inserted through the cervix to remove the fibroids.

Conclusion

The decision to have a myomectomy depends on various factors, including the severity of symptoms, the location and size of the fibroids, and the woman’s plans for pregnancy. A consultation with a fertility specialist can help determine the best approach to treating uterine fibroids, improving fertility chances and ensuring a healthy pregnancy. Women should be fully informed about the benefits, risks and possible alternatives to this procedure.

Uterine fibroids play an important role not only in the ability to conceive, but also in how the pregnancy develops. Proper treatment, especially if they deform the uterus, is crucial for improving fertility and minimizing risks during pregnancy. Women with fibroids who are considering pregnancy should see a fertility specialist for a comprehensive assessment and individualized treatment plan. It is important to make informed treatment decisions, taking into account the benefits and risks of the different treatment options.