Uterine fibroids: impact on fertility and pregnancy
- Posted on 26/08/2022 12:51
- Film
- By abelozih@sante-education.tg
Extract from the article: Les fibromes utérins sont des tumeurs bénignes (non cancéreuses) situées sur la paroi de l’utérus, de façon isolée ou en groupe. La majorité d’entre eux ne limitent pas les chances de tomber enceinte. Mais, dans certains cas, ces tumeurs bénignes peu
Uterine fibroids are benign (non-cancerous) tumours
located on the wall of the uterus, either singly or in groups. The majority of them do not limit the chances
of becoming pregnant. But in some cases, these benign tumours can
have an impact on fertility or even during pregnancy.
Benign tumours such as uterine fibroids do not
systematically pose problems before or during pregnancy. But in some cases,
depending on their location and sometimes their size, they can have an impact
on fertility or on the progress of the pregnancy. To understand this, we need
to distinguish between several types of fibroid depending on their position.
Intramural fibroids (types 3 and 4)
This is the most common type of fibroid. It develops
in the central part of the uterine muscle, known as the myometrium. It is
rarely a barrier to pregnancy. However, in rare cases, the fibroid is so large
that it can cause problems during implantation of the egg in the uterus (by
deforming the cavity of the uterus). Surgery may then be recommended. Studies
have also shown that fibroids larger than 4 cm, even if they do not deform the
uterine cavity, can prevent the onset of pregnancy by disrupting the contractility
of the myometrium.
During pregnancy, due to the increase in oestrogen
levels, the intramural fibroid tends to enlarge. If it grows large and rapidly,
it can become necrotic and cause severe inflammation of the uterine muscle,
with pain in the lower abdomen and possibly premature uterine contractions,
which in extreme cases can lead to premature delivery.
Subserous fibroids (types 5 and 6)
This type of fibroid is located on the outer surface
of the uterus and is rarely symptomatic. There are therefore few indications
for treating it.Since the subserous fibroid has no impact on the uterine muscle
or cavity, it has no influence on fertility.
The only possible problem during pregnancy is if the
fibroid grows. In this case, it may cause necrosis and pain, with a possible
premature uterine contraction during pregnancy. The most external fibroids,
attached to the uterus by a tiny pedicle (pedunculated fibroids), can also
twist on their axis as they grow and cause very painful necrosis (during and
outside pregnancy).
Submucosal or endocavitary fibroids (type 0, 1 or 2)
These are the rarest fibroids, at least in isolated
form. They form under the mucous membrane of the uterine cavity (wall lining
the inside of the uterus). Whatever their size, they have a detrimental effect
on fertility, as they prevent the egg from implanting in the uterine
cavity.Fibroids also cause heavy periods, which can lead to anaemia.It is
important to correct this anaemia before pregnancy, because once pregnant, the
mother-to-be is more prone to iron deficiency.
For all these reasons, this type of fibroid is
generally surgically removed in women who wish to become pregnant.
Abel OZIH
Article validated by Dr Dédé Bénédicta Améwoui, Obstetrician and Gynaecologist (Lomé)