Uterine Fibroids: Treatment Options and Fertility Concerns

Uterine fibroids

Hello Doctor, I have uterine fibroids.
I consulted with a gynecologist who said that if I need surgery, I would have to have my uterus removed.
Since I am not familiar with this condition, I would like to ask you.
My mother thinks that surgery is an option because I am unmarried and have not engaged in sexual activity.
Can uterine fibroids cause infertility? My doctor mentioned that I am overweight and advised me to lose weight.
He said my fibroids are quite large, but I don't know how big they are.
He recommended that I eat a light diet because I experience severe pain that keeps me stuck in the bathroom, along with pain in my upper body and frequent vomiting, which makes it difficult for me to eat.
I am currently not taking pain medication; I used to buy it myself because I felt that taking it made the pain worse.
Although I find relief with heat therapy, I often end up with blisters from the heat, which is very painful.
Even though the doctor advised against it, the pain is so severe that I still apply heat to those areas despite the blisters.

Zhenzi, 30~39 year old female. Ask Date: 2013/03/28

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, the main symptoms of uterine fibroids are dysmenorrhea and heavy menstrual bleeding.
The initial approach is generally conservative treatment, which includes pain relievers, uterotonics, hemostatic agents, and even hormonal medications to suppress menstruation, thereby alleviating dysmenorrhea and heavy bleeding.
Surgery is only considered if these treatments are ineffective.
Typically, for gynecological patients with fibroids, surgical intervention is considered when the size is over 5 centimeters, or if there are symptoms such as dysmenorrhea or heavy menstrual bleeding.
For patients approaching menopause, observation may be recommended.
The decision to proceed with surgery should be based on a comprehensive evaluation of various factors rather than a single consideration.
Based on your situation, along with the fact that you have not had children, I believe observation is still a viable option, and there is no urgent need for surgery at this time.
This assessment is based solely on your symptoms; however, if you have any concerns, please consult a common gynecologist.
Wishing you good health, Dr.
Tsao Kuo-Tao, Chief of the Department of Obstetrics and Gynecology, Taipei City Hospital.

Reply Date: 2013/03/28

More Info

Uterine fibroids, also known as leiomyomas, are non-cancerous growths that develop in the uterus. They are quite common, especially among women of reproductive age. Understanding the implications of fibroids on fertility and the available treatment options is crucial for women who are considering pregnancy or experiencing symptoms.

Impact on Fertility
Fibroids can potentially affect fertility, but their impact varies depending on several factors, including their size, location, and number. Submucosal fibroids, which grow just beneath the uterine lining, are more likely to interfere with implantation and can lead to complications during pregnancy. On the other hand, fibroids located in the muscular wall of the uterus (intramural) or on the outer surface (subserosal) may not significantly affect fertility.

In your case, since you mentioned that your fibroids are large and causing significant pain and discomfort, it’s essential to address these symptoms. While fibroids can cause heavy menstrual bleeding, pelvic pain, and pressure symptoms, they do not always lead to infertility. However, if you are experiencing severe symptoms, it may be worth discussing treatment options with your healthcare provider.

Treatment Options
1. Medications: For symptomatic relief, medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain. Hormonal treatments, like birth control pills or hormonal IUDs, may also help regulate menstrual cycles and reduce bleeding.

2. Minimally Invasive Procedures: If your fibroids are causing significant issues, procedures such as uterine artery embolization (UAE) can shrink fibroids by cutting off their blood supply. This is less invasive than surgery and can preserve the uterus.

3. Surgical Options: If the fibroids are large or causing severe symptoms, surgical options may be necessary. Myomectomy is a procedure that removes fibroids while preserving the uterus, making it a suitable option for women who wish to maintain their fertility. However, if the fibroids are extensive or if there are other complications, a hysterectomy (removal of the uterus) may be recommended, especially if you are not planning to have children in the future.

4. Lifestyle Changes: Your doctor has advised weight loss, which can be beneficial. Maintaining a healthy weight can help reduce the severity of symptoms and improve overall reproductive health. A balanced diet rich in fruits, vegetables, and whole grains, along with regular exercise, can also contribute positively to your health.

Managing Symptoms
Since you are experiencing significant pain and discomfort, it’s crucial to communicate these symptoms to your healthcare provider. While heat therapy can provide temporary relief, it’s essential to be cautious to avoid burns or blisters. If over-the-counter pain medications are not effective, your doctor may prescribe stronger pain relief or recommend alternative therapies.

Conclusion
In summary, while uterine fibroids can pose challenges to fertility, many women with fibroids can conceive and have healthy pregnancies. It’s essential to work closely with your healthcare provider to determine the best course of action based on your specific situation. If surgery is recommended, discussing the potential risks and benefits, as well as the implications for your fertility, is vital. Don’t hesitate to seek a second opinion if you feel uncertain about your treatment options. Your health and comfort are paramount, and there are various avenues to explore for managing fibroids and their symptoms effectively.

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