Why I Wear White: The Relationship Between Fibroids and Fertility
Authored by: Dr. Kelly N. Wright, Minimally Invasive Gynecologic Surgeon, Assistant Professor, Obstetrics & Gynecology, Cedars-Sinai Medical Center
When I was in medical school studying to become a surgeon, I realized very quickly that I wanted to find a specialty that would allow me to both prevent and treat illness, and make real connections with my patients. Working in Gynecology posed a special opportunity to not only treat women at all stages of life, but also play a role in educating and empowering them to take control of their own health. As a minimally invasive gynecologic surgeon, the condition I most commonly treat patients for is uterine fibroids. Fibroids can impact up to 80% of women by age 50, and can cause physically painful symptoms like heavy periods, cramps, pelvic pressure or pain, backaches, and more.2 But what some women don’t know is that fibroids can also contribute to issues with fertility and pregnancy. So, as we push towards greater awareness of fibroids, it is equally important that we discuss the facts about the impact fibroids can have on fertility.
How do fibroids affect fertility?
First, I’ll start by caveating that fibroids don’t always have symptoms, and they don’t always have an impact on fertility. Each woman’s experience is different, and she should work with her doctor to understand how (if, at all) fibroids are impacting her body, and what treatment options might be necessary. That said, fibroids can impact fertility and pregnancy in several ways. They can inhibit a woman’s ability to conceive by blocking the fallopian tubes or distorting the endometrial cavity1, and can create issues during pregnancy and labor, or even contribute to miscarriage. Because fibroids tend to grow as a result of an increase in hormones, they can also potentially grow as the uterus expands during pregnancy,2 resulting in complications.
Get the facts on treatment
To understand how we’ll treat fibroids, we must first understand symptoms. For fibroids that aren’t causing symptoms, we’ll keep a close eye on the growth and severity of the fibroid(s) but will not operate unless we see a risk. In cases when symptoms are present and negatively impacting a woman’s quality of life, like in the case of women dealing with fertility issues, we may pursue minimally invasive surgical options like hysteroscopic myomectomy or laparoscopic myomectomy to remove the fibroids while preserving the uterus. In my experience, these options are the most common, and most successful, for fibroid treatment to improve fertility outcomes.
If a fibroid is very large, or if there are too many, doctors may recommend hysterectomy, an operation to remove the uterus.2 However, very rarely is hysterectomy the only option, so it’s important for women to understand the breadth of treatment options available to them before making such an important decision about their health. The treatment method and approach for symptom management is dependent upon many factors – presence of symptoms, volume of fibroids, type, and location in the uterus. As with any medical scenario, each woman’s situation is completely unique– so it is critical that you have an open dialogue with your doctor to find a solution that works for you.
Remaining hopeful and raising awareness
I want to make sure that women who are struggling with fibroids know that they have options to manage their symptoms and improve their ability to conceive, if that is a factor. I’ve had the pleasure of being visited by former patients who underwent treatment via myomectomy, and stopped in with their new (and healthy!) babies to thank the team. Seeing what a lasting impact such a short procedure can have on a woman’s life has been one of the most gratifying parts of my career as a gynecologist and minimally invasive surgeon. I hope to encourage women to keep seeking out treatment options that work for them, continue speaking up, and to not lose hope.
Women’s health issues like fibroids are underdiscussed and under-researched, which is why I’m proud to support Change the Cycle in their mission of raising awareness and supporting women with fibroids. It’s on us to keep spreading the word to our sisters, cousins, friends and colleagues to make sure that women are talking about their symptoms, and proactively asking questions. Women have the power to keep the conversation going to promote a shift in how we talk about these issues, which can impact how (and how frequently) research is conducted, and ultimately increase broader awareness and access. Join the movement by simply sharing your #MyFibroidStory, or #WhyIWearWhite
-Dr. Wright
References
- Catherine G. Xiaoxiao and James H. Segars. The Impact and Management of Fibroids for Fertility: an evidence-based approach. Obstet Gynecol Clin North Am. 2012 Dec; 39(4): 521–533
- Uterine Fibroid Fact Sheet. Office on Women’s Health. U.S. Department of Health & Human Services. https://www.womenshealth.gov/a-z-topics/uterine-fibroids.