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March 30th 2016

A Threat To Fertility: The Quiet Symptom Of Fibroids

Eight years ago, Raynelle was told she had fibroids, smooth tumors that grow within or attach to the outside of the uterus. In Raynelle’s case, her fibroids weren’t affecting her daily life, but as she discovered years later, they posed a threat to her ability to carry a baby without complications. Many women are unaware that a quiet symptom of fibroids is that it can get in the way of fertility or carrying a child safely to term.

“At first, I didn’t know anything was wrong,” said Raynelle. “I did not have any symptoms from my fibroids. I would get normal period pain, occasionally. During an exam, my uterus didn’t feel quite right, so my OB/GYN sent me for a sonogram.”

Early detection and minimally invasive fibroid removal is the most effective treatment for women who suffer with painful, prolonged, or heavy periods. However, many OB/GYNs or general practitioners advise women to watch them and wait, but to let them know if their symptoms change. However, this can be subjective, as a patient may not know what to look for if the fibroids aren’t causing overt or rapid changes.

Watching and waiting is an out-of-date approach to managing fibroids, and can lead to major problems when it comes to getting pregnant and carrying a baby to term.

Fibroids are one many possible causes of infertility. The location, and not necessarily the size are often the major consideration. However, large fibroids can block fallopian tubes not allowing an embryo to pass into the womb, or create uterine distortion so that an embryo is not able to properly attach to the womb. Submucosal fibroids, those in the uterine cavity, and intramural fibroids, those within the uterine muscle are the most troublesome for fertility.

During pregnancy, fibroids can grow simultaneously with the baby. The increased blood flow to the uterus to help the sustain a growing baby can also feed the fibroids. Miscarriages, and pre-term births can occur. Depending on the placement, fibroids can cause placental abruption (detaching the placenta from the uterine lining), and they can also create barriers to delivery if a fibroid blocks the birth canal, forcing emergency Cesarean sections.

In many cases, fibroid symptoms can get worse slowly, and women often accept that pelvic pain and heavy bleeding are normal when they are actually signs of a complex GYN condition. Other times, and especially when there is increased blood flow to the uterus, as with a pregnancy, fibroids can grow very large, very fast.

“The fibroids weren’t causing any day-to-day issues, but each year they were getting bigger. As my husband and I started thinking we wanted to have children, I realized that I needed to get checked out. My OB/GYN said that the fibroids were now the size of a small grapefruit or an orange, and there would be no room in my torso for them and a baby. She recommended an open myomectomy.”

Open fibroid removal procedures can take 6-8 weeks of recovery. These procedures require large incisions like a c-section, cutting through skin, fat, muscle and then into the uterus. It can be hard to control bleeding during these procedures. While fibroid removal can be thorough with an open procedure, patients experience a great deal of pain during the long recovery. Robotic or other laparoscopic fibroid removal procedures can take a long time to perform, and they are not able to remove all types of fibroids nor allow the surgeon to feel for additional tumors that may not appear on imaging. Both open and robotic myomectomies have a higher incidence of complications and often require additional surgeries to repair delicate structures.

A Laparoscopic Assisted Abdominal Myomectomy or LAAM procedure developed by the minimally invasive GYN specialists at The Center for Innovative GYN Care takes the best of both open and laparoscopic procedures, for a safer, more thorough surgery that has a faster recovery with less pain. Using 1 tiny incision for the laparoscope at the belly button, and 1 small cut about 1.5 inches at the bikini line, all fibroids, of any size are able to be removed. Blood loss is controlled by placing a temporary tourniquet at the neck of the uterus. This allows the surgeon to work efficiently.