Dr. Komaroff, 1-31-12: Fibroids may not preclude pregnancy

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DEAR DOCTOR K: I am a 31-year-old woman who was recently diagnosed with uterine fibroids. I would like to have children in the future, so I'm afraid that treating my fibroids may affect my fertility.

DEAR READER: Fibroids are non-cancerous tumors in the uterus. Only about a quarter of women with fibroids have symptoms. However, the symptoms can be severe and can affect day-to-day life. Heavy bleeding, pelvic pain, having to pass urine frequently or difficulty passing urine are the most common symptoms.

Some women who plan to have children choose not to treat fibroids until afterward. But for some, the symptoms are too painful or inconvenient to wait.

If you decide you need treatment, be very clear with your doctor about your plans to have children. Some treatments are completely incompatible with pregnancy.

The only sure-fire way to get rid of fibroids is with a hysterectomy, or removal of the uterus. This cures fibroids completely, since it removes them from your body. But it would leave you unable to have children. It's a good choice for women who don't want to have kids (or more kids), but not for you.

For women who do want to have kids, there are other treatments. Certain hormone therapies can help keep your fibroids from growing bigger and can reduce your symptoms. There are too many specific hormone treatments available to mention them here, but your gynecologist can discuss them with you.

Another option is a surgery that removes the fibroid tumors in your uterus, but leaves the healthy tissue of the uterus in place. One concern with this type of surgery is that it can weaken the uterus. A uterus weakened by surgery may not be strong enough to endure pregnancy. In some cases, a cesarean section (C-section) may be needed to prevent uterine damage during delivery.

If your main symptom from fibroids is bleeding, there is one approved drug, tranexamic acid, that might help. If your main symptom is pain, strong doses of non-steroidal anti-inflammatory drugs (called NSAIDs) may help.

There is a widely used treatment called uterine artery embolization. This cuts off the blood supply to the fibroid tumors and causes them to shrink. Symptoms usually improve. However, I wouldn't recommend it to someone who wants to have more kids, as it can reduce the chances of a successful future pregnancy.

There are other treatments that don't involve surgery or medicines. Some are too new to say whether they affect fertility. Therefore, I would recommend them only to my patients who don't plan on having children in the future.

Deciding how to treat your fibroids is an individual decision based on your age, symptoms and future childbearing plans. Your best first step is a frank talk with your doctor.

(Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.)

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