FIBROID AND FERTILITY (PART 1)

The reason some women will have fibroid at some time in their life is simply because they are women and not because they have broken any health rule. This introduces us to this week’s discussion centred on FIBROID AND FERTILITY.

WHAT IS FIBROID?

Uterine fibroids are benign (non- cancerous) abnormal growths of muscle cells and fibrous tissue within the uterus (womb). They are also called myomas or leiomyoma. Fibroid occur when a single muscle cell in the wall of the uterus multiplies and grows to form a non-cancerous tumor. It is a medical fact that most women will have fibroids during their lifetime. Usually, fibroids development occurs when a woman is in her thirties or forties. In the past, women of this age would have completed a family. But today, many women have children later in life due to career progression, urbanization, and other factors. It is more common now to start a family in the thirties or even forties, rather than early twenties. Fibroid can change the size and shape of the uterus and sometimes the cervix (lower part of the uterus/womb). Women usually have more than one fibroid tumor but single fibroids are possible. Whether fibroid may cause symptoms or requires treatment depends on their number, location and size. This makes understanding the potential relationship between fibroids and infertility very important.

WHERE DO FIBROIDS GROW?

Fibroids are usually found in or around the body of the uterus (womb), but sometimes are in the cervix. These locations determine the type and possible effect on the woman.
• Outside or within the outer lining (Sub serosal)
• On stalks, extending from the uterus (Pedunculated)
• Within the uterine muscle (Intramural)
• Between the uterine broad ligaments (Submucosal)
Submucosal fibroid are the type of fibroids that have clearly been demonstrated to reduce pregnancy rate, roughly by 50% and removal of which will double pregnancy rate. In some cases simply removing the submucosal fibroid solves infertility. Often, but not always, submucosal fibroids can use heavy periods, or bleeding between periods.
Cervical fibroids are rare; most fibroids develop from the uterine muscle (myometrium).
Fibroids can also be connected to the uterus by a stalk (pedunculated), or organs, such as the bladder and bowel. Fibroids are rarely found outside the cavity.
HOW COMMON ARE FIBROIDS?

Fibroids are quite common and found in 20 -80% of women of reproductive/childbearing age developing even till about age 50 in some women.

30% of women between the ages of 25-44 years have various symptoms.. Fibroids are more common in African-American women up to 50%-80%.

CAUSES OF FIBROIDS

Although the exact cause is unknown, the growth of fibroids seems to be related to a gene that controls cells growth. When the gene functions normally, cells grow normally. When the gene is not functioning, cells grow and divide at an accelerated rate in this way, one cells becomes two, two cells becomes four etc. until finally a mass or fibroid of this cells is detected. Fibroid growth is affected by the reproductive hormones estrogen and progesterone. When these hormone levels decrease at menopause, many of the symptoms or fibroids begin to resolve. However, it is not clear whether theses hormones actually cause the fibroids to occur. For example, women who have had high levels of both of these hormones as a result of pregnancy or birth control pills have a lower incidence of fibroids later in life.

Abnormalities in the blood vessels around the uterus may play a role in development of fibroids.

Chemical changes of the body that causes tissue to grow may also be involved as the cause of these abnormal growths.

WHAT ARE THE SYMPTOMS OF FIBROIDS?

Some women do not experience any symptoms and have no complications throughout life.
The symptoms of fibroids also depend on the location and size of the fibroid.
• Change in menstrual flow which may be excessively heavy (menorrhagia) which includes blood clot, irregular menstruation, increased menstrual cramping and pain, spotting.
• Pain in the pelvis or lower back
• Pain during intercourse
• Pressure or fullness in the lower abdomen with increased urination.
• Swelling or enlargement of the abdomen.

RISK FACTORS FOR FIBROIDS

A number of factor influence the risks of developing fibroids. These include:
• Number of pregnancies: Women with one or more pregnancies that extended beyond 5 months have a decreased risk of fibroid formation.

• Use of birth control pills: Use of birth control pills can generally protect against fibroids, but the use of the birth control at an early age (between age 13 and 16) may be associated with an increased risk for fibroid)………………………..TO BE CONTINUED