Reproductive issues in women with uterine leiomyomas (fibroids)
- Togas Tulandi, MD, MHCM
Togas Tulandi, MD, MHCM
- Professor of Obstetrics and Gynecology
- Milton Leong Chair in Reproductive Medicine
- McGill University, Canada
The management of women with uterine leiomyomas depends upon several factors, including the patient's age and symptoms, her obstetrical history and future childbearing plans, and the size and location of the leiomyomas. A general approach to counseling women with leiomyomas about reproductive issues will be reviewed here. Effects of fibroids during pregnancy and other fibroid-related issues are discussed in detail separately (see individual topic reviews). (See "Pregnancy in women with uterine leiomyomas (fibroids)".)
A uterine leiomyoma in an asymptomatic woman is usually an incidental finding. Although some of these tumors will naturally regress, others will continue to grow and new leiomyomas may develop. (See "Uterine leiomyomas (fibroids): Epidemiology, clinical features, diagnosis, and natural history", section on 'Natural history'.)
Use of low dose estrogen-progestin contraceptives does not cause leiomyomas to grow; therefore, administration of these drugs is not contraindicated in women with leiomyomas who wish to use this method of contraception. One possible exception is girls with exposure to estrogen-progestive contraceptives between the ages of 13 and 16 years . In adolescents, the advantages of estrogen-progestin contraceptives need to be weighed against this potential risk. (See "Uterine leiomyomas (fibroids): Epidemiology, clinical features, diagnosis, and natural history", section on 'Hormonal contraception'.)
We suggest that women with leiomyomas not postpone pregnancy for a prolonged period of time, if possible. Our rationale is that fertility naturally declines with age, especially after age 35 years, and leiomyomas may impair fertility and adversely affect pregnancy outcome (see 'Infertility and miscarriage' below).
There are no well-designed studies that provide high-quality data on whether leiomyomas adversely affect pregnancy outcome. Instead, the available information consists largely of observational case series and case reports that are limited by different patient populations; different criteria regarding the size, location, and number of leiomyomas; small numbers of adverse events; ascertainment bias in selecting study participants; and inadequate adjustment of confounders.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- ASYMPTOMATIC LEIOMYOMAS
- PRECONCEPTIONAL PLANNING
- INFERTILITY AND MISCARRIAGE
- Preparing for in vitro fertilization
- OPTIONS FOR TREATMENT OF LEIOMYOMAS
- Medical therapy
- Myomectomy versus embolization
- Route of myomectomy
- - Hysteroscopic myomectomy
- - Abdominal myomectomy
- - Laparoscopic myomectomy
- Miscellaneous techniques
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS