Uterine Fibroids: Growth, Treatment, and Fertility Concerns

Uterine fibroids

Hello Doctor,
I have a few questions:
1.
Last year on May 1st, I was diagnosed with a uterine fibroid measuring 1.2 x 0.8 x 1.2 cm.
During my follow-up on September 6th this year, the fibroid had grown to 1.9 x 1.9 x 1.9 cm.
Is this growth too rapid? Under what circumstances should treatment be considered? Is it possible for the fibroid to disappear? Additionally, the doctor mentioned that the fibroid has calcification.
What does that mean? Will it affect my fertility? Should I seek confirmation at a larger hospital?
2.
I have cervical erosion, and the doctor suggested cauterization.
Is this procedure necessary for me?
3.
I experience lower abdominal pain after sexual intercourse.
What could be the cause?
4.
I have a history of six hospitalizations due to kidney inflammation (all acute pyelonephritis), two pelvic inflammatory diseases, and I have completed treatment for tuberculosis (finished on June 10, 2009).
After treatment, I have been resting and recuperating, but my health has significantly declined compared to before.
I get tired easily, and my body feels very hot, with a higher temperature than average.
I have been wanting to have a child but am hesitant due to two concerns: 1.
I fear my kidneys may not be able to handle it, and 2.
I worry about the possibility of having an abnormal child due to multiple antibiotic treatments and nine months of tuberculosis medication.
What should I do? How can I ensure a safe delivery of a healthy child? I would greatly appreciate your advice.
I apologize for having so many questions, and thank you for your patience in answering them.

jane, 30~39 year old female. Ask Date: 2010/09/29

Dr. Lü Lizheng reply Obstetrics and Gynecology

Dear Jane,
1.
Your fibroids are still very small, so there is no need to worry.
Just make sure to have regular follow-ups.
The calcification of the fibroids is not a concern; it is simply a deposition of calcium and will not affect fertility.
2.
Cervical erosion does not necessarily require cauterization.
You can discuss this further with a physician at a larger hospital.
3.
Experiencing lower abdominal pain after sexual intercourse could be due to several possible reasons, including uterine inflammation, endometriosis, or pelvic adhesions.
4.
The use of antibiotics does not affect pregnancy.
However, since you have had two instances of pelvic inflammatory disease, I am unsure if there has been any inflammation of the fallopian tubes and whether they remain patent.
You may try to conceive first, and if you encounter difficulties, we can discuss the possibility of fallopian tube obstruction with your physician.
Wishing you peace and health.
Sincerely,
Dr.
Li-Cheng Lu
Director, Department of Obstetrics and Gynecology
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2010/09/29

More Info

Understanding uterine fibroids is crucial for women who are considering pregnancy or experiencing reproductive health issues. Uterine fibroids, also known as leiomyomas, are non-cancerous growths that develop in the uterus. They can vary in size, number, and location, and their growth can be influenced by hormonal changes, particularly estrogen.
1. Growth of Fibroids: In your case, the increase in size from 1.2 cm to 1.9 cm within a year is notable, but the rate of growth can vary significantly among individuals. Fibroids can grow quickly in some women, while others may experience little to no change over time. Factors such as hormonal levels, age, and overall health can influence fibroid growth. If a fibroid is growing rapidly or causing symptoms such as heavy menstrual bleeding, pelvic pain, or pressure symptoms, it may require further evaluation and treatment.
Fibroids can sometimes shrink or even disappear, particularly after menopause when estrogen levels decline. However, this is not guaranteed, and monitoring is essential. The presence of calcification in fibroids indicates that the fibroid has undergone changes, often due to aging or degeneration. Calcified fibroids are generally less likely to cause symptoms and may not significantly affect fertility.

2. Fertility Concerns: While many women with fibroids can conceive and have healthy pregnancies, certain types of fibroids, particularly submucosal fibroids (which grow into the uterine cavity), can interfere with implantation and increase the risk of miscarriage. If you are considering pregnancy, it may be beneficial to consult with a fertility specialist or a gynecologist who can assess the specific characteristics of your fibroids and their potential impact on your fertility.

3. Cervical Erosion: Regarding your cervical erosion (cervical ectropion), this condition is common and often does not require treatment unless it causes significant symptoms, such as bleeding or discomfort. Electrocautery is one treatment option, but it is not always necessary. Discussing the risks and benefits with your healthcare provider can help you make an informed decision.

4. Post-Sexual Activity Pain: Experiencing lower abdominal pain after sexual intercourse can be due to several factors, including pelvic inflammatory disease, endometriosis, or even the presence of fibroids. Given your history of pelvic inflammatory disease, it is essential to discuss this symptom with your healthcare provider to rule out any underlying conditions that may require treatment.

5. Concerns About Pregnancy: Your history of kidney infections and tuberculosis treatment raises valid concerns about your overall health and its impact on pregnancy. It is crucial to ensure that your kidney function is stable and that you are in good health before attempting to conceive. Regular check-ups with your healthcare provider can help monitor your health status.
To prepare for a healthy pregnancy, consider the following steps:
- Preconception Counseling: Schedule a visit with a healthcare provider specializing in preconception care. They can assess your overall health, review your medical history, and provide personalized recommendations.

- Healthy Lifestyle: Focus on maintaining a balanced diet, regular exercise, and managing stress. These factors can improve your overall health and enhance fertility.

- Supplements: Consider taking prenatal vitamins that include folic acid, which is essential for fetal development and can help prevent neural tube defects.

- Monitoring: Regular monitoring of your fibroids and overall reproductive health is essential. If you notice any changes or new symptoms, seek medical advice promptly.

In conclusion, while uterine fibroids and your medical history may pose challenges, many women with similar conditions successfully conceive and have healthy pregnancies. Open communication with your healthcare provider and a proactive approach to your health will be key in your journey toward parenthood.

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