How it’s tested
A fertilized egg must implant itself in your uterus in order to start growing into a baby. There are two things eggs usually need to implant successfully:
- Lining that’s rich with blood
- Implanting at the “fundus”, the top centre part of your uterus
If you don’t have any fibroids at all, the fertilized egg will find your nice, blood-rich fundus and burrow in. The problem with fibroids is that like any tumor, they use up nearby resources – like blood – for themselves.
So if you have a fibroid near your fundus, it’ll use up the blood that makes it possible for the egg to implant there. Even a tiny fibroid near your fundus will probably hurt your fertility, so it should be removed during a hysteroscopy.
You can also have a large fibroid that’s nowhere near your fundus, but it’s so big that it deprives your whole uterus of blood, causing implantation difficulties for the egg.
As a general rule, “submucosal” fibroids are a little more serious, because they’re on the inside of your uterus. “Impinging” fibroids are also more serious, because it’s means they’re actually sticking out into your uterus cavity.
“Subserosal” fibroids are the least serious; they’re on the outside of your uterus and are usually only a problem if they’re really large. Some doctors think a fibroid is too large when it’s 5cm in size, others think 10cm or more. As a general rule, if it’s so large that it’s denting the shape of your uterus or using up too much blood, it should be removed with a myomectomy.
If you have many smaller fibroids – for example, five fibroids that are just 3cm in size – there’s no single answer to whether you should have a myomectomy or not. It’s a complication question, and different doctors and surgeons will have different opinions.
The symptoms of fibroids are usually long, heavy periods and pelvic pain. However, many women with fibroids won’t present these symptoms.
You can go for a transvaginal ultrasound to determine if you have fibroids. It can also help to do a three-dimensional sonohystogram to figure out if the fibroid is impinging on your uterus cavity. An MRI can indicate the specific sizes of the fibroids.
However, many fibroids are discovered or ruled out by accident…right in the middle of surgery! It’s not unusual for a surgeon to be surprised during a hysteroscopy, laparoscopy, or complete laparotomy. A condition like adenomyosis can look like fibroids from “the outside”, but can’t be removed easily like fibroids can.
How it’s treated
The only active treatment for fibroids is a myomectomy: surgically removing them.
Women who aren’t trying to get pregnant can attempt to shrink their fibroids instead. Using radiology to cut off some blood flow to your uterus can “starve” the fibroids. You can also shrink them by reducing your estrogen with a medication like Depot Lupron for one to three months.
However, neither of those two fibroid-shrinking methods are ideal when you’re trying to get pregnant. Cutting off the blood to your uterus will make it hard for an egg to implant, and once you go off Depot Lupron your body’s own menstrual cycle will raise estrogen levels enough to grow your fibroids back. So if you’re trying to get pregnant, a myomectomy is the usual solution.
After you heal from your myomectomy, we strongly recommend trying to get pregnant as quickly and efficiently as possible – usually with IVF, which has the highest success rates.
That’s because women who had fibroids in the past are likely to keep growing new ones, which could mean you’ll end up with fertility-harming fibroids again, even though you had the first “batch” surgically removed! And you can’t just have the same surgery twice: a myomectomy can be really tough on your uterus, so doing it more than once can weaken your uterus to the point that it can’t safely carry your pregnancy.
If you’re feeling a little nervous about the myomectomy’s effect on your uterus, don’t be afraid to get a second opinion from a different doctor before you have the surgery.