Uterine fibroids (also called myomas or leiomyomas) are non-cancerous tumours of muscle tissue. They can change the size and shape of the uterus and sometimes of the cervix. Fibroids start in the smooth muscle cells of the uterine wall (myometrium) and are usually multiple; a single fibroid is less common.
Fibroids are seen in about 20% of women of reproductive age, and they are more common in women of African descent (50–80%). Their symptoms and treatment depend on their location in the uterus and their size. Fibroids develop when muscle cells in the uterine wall multiply, for reasons not yet fully understood, and form a non-cancerous tumour. Although the exact cause is unknown, genetic, hormonal and environmental factors are thought to play a role.
Fibroids usually develop in or around the uterus, but they can occasionally form in the cervix. Fibroids of the uterus are divided into three categories:
- Subserosal: fibroids on the outer wall of the uterus
- Intramural: fibroids within the muscle layers of the uterine wall
- Submucosal: fibroids that bulge into the uterine cavity
About 55% of fibroids are subserosal, 40% intramural and 5% submucosal.
What treatment options are used for fibroids?
Medication is not a permanent solution for fibroids. Surgical removal should be considered only when it is clear that the fibroid is causing infertility, because surgery itself carries a risk of affecting fertility through adhesions and scar tissue. Surgical options include:
- Open myomectomy (laparotomy): In this classic method, the surgeon reaches and removes the fibroid through an incision in the abdominal wall. Recovery can take 4–6 weeks.
- Laparoscopic myomectomy: The surgeon reaches and removes the fibroid with a laparoscope inserted through small incisions (5–10 mm) in the abdomen. Recovery takes 2–7 days.
- Hysteroscopic myomectomy: The surgeon reaches and removes the fibroid with a hysteroscope passed through the cervix. Patients can usually return to daily activities the same day. This method is mainly recommended for submucosal fibroids.
- Robotic myomectomy: In this relatively new method, the surgeon reaches and removes the fibroid with robotic assistance through small abdominal incisions. Recovery takes a few days.
- Hysterectomy: Because the whole uterus is removed, this method is suitable only for patients who no longer plan to have children. It can be performed as open surgery (laparotomy), vaginally or sometimes laparoscopically. Recovery takes 2–6 weeks.
How fibroids affect fertility
Fibroids can contribute to infertility in several ways, including:
- Changing the position of the cervix
- Changes in the shape of the uterus affecting sperm movement
- Blocking the fallopian tubes
- Affecting blood flow to the uterine cavity where the embryo implants
- Changes in the uterine muscle hindering the movement of sperm or the embryo
Fibroids during pregnancy
In some cases fibroids can cause severe pain. They can also change the baby’s position during birth, which increases the risk of caesarean delivery, miscarriage and preterm birth. For these reasons, fibroids should be closely monitored by your doctor during pregnancy.