Symptoms
In many women, fibroids cause no problems. Some women, however, may experience pelvic pain, unusually heavy menstrual periods, or fertility problems. In some women, fibroids can cause recurrent miscarriages.
Do Fibroids Cause Miscarriage?
According to a 2000 study, fibroids are the exclusive culprits in 5% of women who are infertile or miscarry. Doctors believe that the reason why fibroids cause problems for some women and not others have to do with the type and size of the fibroid and its location in the uterus. For instance, if the fibroid is closer to the middle of the uterus, where a fertilized egg is more likely to implant, then the fibroid is more likely to cause a miscarriage. Fibroids that stick out into the uterine cavity and change its shape (submucous fibroids) and ones that are within the uterine cavity (intracavity fibroids) are more likely to cause miscarriages than ones that are within the uterine wall (intramural fibroids) or bulge outside the uterine wall (subserosal fibroids). A large fibroid tends to be more problematic than a small one.
Diagnosis
Doctors frequently diagnose fibroids by doing a pelvic exam. If someone is having miscarriages or fertility issues, the doctor may also order a hysterosalpingogram (HSG) or a sonohysterogram. During an HSG, a 30-minute outpatient procedure, an iodine-based dye is placed through the cervix and x-rays are taken. A sonohysterogram involves injecting saline solution into the uterus and examining it with ultrasound.
Treatment Options
Multiple treatments exist for fibroids, and women who have no negative symptoms associated with their fibroids may not even need treatment. The most drastic treatment for fibroids is a hysterectomy (removal of the entire uterus)—a treatment that would obviously not work for anyone who has a goal of getting pregnant again. Medications that can shrink fibroids also exist, as do other surgical procedures that are less drastic than hysterectomy. One procedure called uterine artery embolization halts the blood supply to the fibroid and has shown increasing success, but the safety of pregnancy after the procedure is unknown. The downside of myomectomy as a fibroid treatment is a significant chance of the fibroid recurring; 10% to 25% of women who choose myomectomy as a fibroid treatment will need a repeat myomectomy in the future because of new fibroids. In addition, women who have had a myomectomy may have an increased risk of uterine rupture during pregnancy and will need to be followed extra closely during prenatal care.
