Fibroids & Polyps

Fibroids and uterine polyps are common, non-cancerous growths of the uterus. While many women have no symptoms, some experience heavy bleeding, pelvic discomfort, miscarriage, or difficulty getting pregnant. When these growths interfere with the shape or lining of the uterus, they can reduce fertility or affect pregnancy outcomes. Careful assessment and tailored treatment can significantly improve reproductive outcomes and overall well-being.

What Are Fibroids?

Fibroids, also known as uterine leiomyomas, are benign growths made of muscle and fibrous tissue that develop within or on the uterus. They can vary in size from a few millimetres to large masses that distort the uterus.

Fibroids are classified according to their location:

• Submucosal fibroids: Grow inside the uterine cavity
• Intramural fibroids: Grow within the muscle wall of the uterus
• Subserosal fibroids: Grow on the outer surface of the uterus

Not all fibroids affect fertility. However, certain types are more likely to interfere with conception or pregnancy.

Which Fibroids Affect Fertility?

Fibroids that are considered to negatively impact fertility include:

• Submucosal fibroids: Growing in the uterine cavity
• Intramural fibroids: These distort the uterine cavity
• Large fibroids: 5 cm or greater in size

These fibroids may:

• Interfere with embryo implantation
• Reduce blood flow to the uterine lining
• Increase miscarriage risk
• Distort the uterine cavity
• Block the fallopian tubes

Symptoms of Fibroids

Many fibroids cause no symptoms. When symptoms occur, they may include:

• Heavy menstrual bleeding: Prolonged or excessive bleeding
• Pelvic pressure or pain: Feeling of fullness in the lower abdomen
• Frequent urination: Due to pressure on the bladder
• Constipation: If pressing on the bowel
• Infertility or miscarriage

Diagnosis of Fibroids

Fibroids are diagnosed through:

• Pelvic examination
• Transvaginal ultrasound: First-line imaging
• Sonohysterography: Saline ultrasound to assess cavity distortion
• MRI scan: For complex or multiple fibroids
• Hysteroscopy: Direct visualisation of the uterine cavity

Treatment for Fibroids

Treatment depends on symptoms, fertility goals, fibroid size, and location.

Hysteroscopic Myomectomy (Submucosal Fibroids)

Submucosal fibroids are removed during a hysteroscopy. This is typically:

• A 30-minute procedure
• Performed under general anaesthetic
• Completed using specialised devices such as a MyoSure system or resectoscope

The fibroid is shaved away from inside the uterus without abdominal incisions. Recovery is usually quick, and pregnancy can often be attempted after approximately 2 months.

Laparoscopic Myomectomy (Intramural Fibroids)

Intramural fibroids that distort the uterine cavity are often removed via minimally invasive laparoscopic surgery.

• Small abdominal incisions are made
• The fibroid is carefully “shelled out” from the uterine muscle
• The uterine wall is repaired with sutures

This approach allows faster recovery compared to open surgery. Pregnancy is usually delayed for 3–6 months to allow proper healing of the uterine wall.

Open Myomectomy (Multiple or Large Fibroids)

If there are multiple or very large fibroids, an open surgical approach may be recommended.

• A 10 cm incision is made above the pubic hairline
• Fibroids are removed individually
• The uterus is carefully reconstructed

This approach is sometimes necessary to ensure safe and complete removal.

Fertility After Myomectomy

Fibroids can regrow over time. Women planning pregnancy are often advised not to delay conception unnecessarily following surgery.

After intramural fibroid removal:

• A healing period of 3–6 months is typically advised
• Future pregnancies are monitored closely

Because incisions are made in the uterine muscle, there is a small risk of:

• Placental implantation problems
• Uterine rupture during labour

For this reason, a Caesarean delivery may be recommended, especially if the uterine cavity was entered during surgery.

What Are Uterine Polyps?

Uterine polyps are soft overgrowths of the endometrium (the inner lining of the uterus) that extend into the uterine cavity. They are usually benign but can occasionally contain abnormal or precancerous cells, particularly in postmenopausal women.

Polyps can range from a few millimetres to several centimetres in size.

Causes and Risk Factors of Uterine Polyps

The exact cause of uterine polyps is not fully understood, but they are influenced by oestrogen.

Risk factors include:

• Age: Most common between 40 and 50 years
• Hormonal imbalance: High oestrogen levels
• Obesity
• Uncontrolled hypertension
• Tamoxifen use: Medication for breast cancer
• Hormone replacement therapy

Although rare in younger women, polyps can occur at any age.

Symptoms of Uterine Polyps

Some women have no symptoms. When symptoms are present, they may include:

• Irregular periods
• Heavy menstrual bleeding (menorrhagia)
• Prolonged bleeding
• Bleeding between periods
• Postmenopausal bleeding
• Bleeding after intercourse
• Infertility or recurrent miscarriage

Polyps may interfere with embryo implantation or increase inflammation inside the uterus.

Diagnosis of Uterine Polyps

Diagnosis may involve:

• Transvaginal ultrasound
• Sonohysterography (saline scan)
• Hysteroscopy: Direct visual confirmation
• Endometrial biopsy: To rule out abnormal cells
• Curettage (D&C): In selected cases

Hysteroscopy remains the gold standard for diagnosis and treatment.

Treatment for Uterine Polyps

Small polyps that do not cause symptoms may be monitored every 6 months.

Removal (polypectomy) is recommended when:

• There are symptoms
• Fertility is affected
• There is a recurrent miscarriage
• There is postmenopausal bleeding
• There are abnormal biopsy results

Hysteroscopic Polypectomy

This is the preferred treatment method.

• Performed under general anaesthetic
• No abdominal incisions
• The polyp is removed using specialised instruments
• Tissue is sent for pathology

Recovery is usually quick, and most women resume normal activities within a few days.

Fertility Outcomes and Prognosis

Removal of submucosal fibroids and polyps has been shown to:

• Improve implantation rates
• Increase natural conception rates
• Improve IVF success
• Reduce miscarriage risk

Outcomes depend on age, ovarian reserve, and the presence of other fertility conditions.