Diagnosis for for Uterine Fibroids
One in 5 women will be diagnosed with uterine fibroids (myomas).  Onset is in the woman’s 30’s-40’s with 25-50% of women of childbearing age.  Some types of fibroids can adversely affect fertility. Symptoms from fibroids are related to their size and location.  Many women with uterine fibroids have no symptoms.  Approximately one-third of women will experience abnormal uterine bleeding, pain, or pressure in the lower abdomen.  Some women will notice a mass which can occasionally be as large as a full-term pregnancy.

Fibroids are benign tumors composed of smooth uterine muscle and connective tissue, and consist of hard fibrous white tissue with limited blood supply.  Sometimes the central mass stops growing only for a series of network fibers to develop in order to bring nutrition to the mass.  This creates an increased density and hardening of surrounding tissues, complicating the possibility for surgical intervention other than hysterectomy.

Although uterine fibroids are common, only about 3% of infertility is caused by fibroids.  In such cases the fibroids are usually submucosal or intramural.  There are several explanations for why uterine fibroids may reduce fertility.  Changes in the endometrium may make it difficult for a fertilized egg to attach to the uterine wall.  In addition, one or both fallopian tubes may be compressed and blocked, preventing the sperm from reaching the egg.  Fibroids may increase miscarriage rates by impairing successful implantation of an embryo. Changes in the endometrium or in the blood supply to the uterus may also cause early miscarriage.  Fibroids can cause early labor and premature delivery.

There are several types of fibroids:
Subserous fibroids which grow towards the outside of the uterus pose little problem unless they become so large they press on abdominal structures.
Submucus fibroids on the other hand are much more troublesome because they affect the endometrium itself. They may cause a considerable increase in the surface area of the endometrium which means periods become much heavier because there is more lining to be shed. Fibroids which stick out into the uterine cavity also interfere with fertility because they may prevent the walls of the uterus from being able to press together to hold an embryo as it attempts to implant.

Intramural fibroids only cause problems when they are large or there are several of them. If they interfere with a large proportion of the surface area of the endometrium then the chances of a placenta developing and functioning properly throughout pregnancy are reduced and there is an increased risk of miscarriage. Intramural fibroids which are large enough to protrude into the endometrial cavity can also interfere with implantation in the same way submucus ones do. Intramural and submucus fibroids can cause heavy or painful periods.