Impact Of Fibroids On Menstrual Cycle 

Introduction 

Uterine fibroids (or just fibroids) are benign tumours, which are harmless growths found in the muscular wall of the uterus. The exact cause of why fibroids form is not completely understood but research suggests that it is linked to genetic and hormonal factors.¹ Fibroids are less common in individuals who haven’t started menstruation and those who have reached menopause. However, fibroids can be a common occurrence during reproductive years. Therefore, sex hormones seem to influence the growth of these tumours.¹

In some cases, there may be little to no symptoms. However, as the tumours grow, they begin to have an impact on the menstrual cycle and your reproductive health. The menstrual cycle provides a great insight into one’s health. ​Typically, the menstrual cycle length averages between 26 and 28 days, but it can range between 21​ and 35 days. A fluctuation in the length of your menstrual cycle can be an indication of a serious health condition, like ovarian cancer and polycystic ovary syndrome, and fibroids.² 

Therefore, it is important to understand how fibroids can interfere with your reproductive health and to know when to visit your health provider. 

Understanding fibroids  

Fibroids are benign tumours, which means they are not cancerous. However, this doesn’t mean that they can’t impact your sexual health. Fibroids have been classified into three types based on the part of the uterus they are found in. When the tumours project from the outer part of the uterus, they are referred to as subserosal. If the fibroid is found within the myometrium (the part of the uterus containing smooth muscles), it is called intramural. Finally, If the tumours are located within the uterine cavity, they are called submucosal fibroids.³

Common symptoms associated with fibroids  

The main symptoms of fibroids are abnormal, heavy and prolonged menstrual bleeding. Other common symptoms include:⁴

• pelvic pressure
• frequent and urgent urination
• urine​ ​retention
• pain in the lower back
• constipation
• bowel dysfunction 
• infertility
• painful urination
• painful sex 
• vaginal bleeding 

Factors that contribute to fibroid development 

Some factors have been established to influence the development of fibroids. One of these factors is race. Research has reported a higher prevalence of fibroids among people assigned female (AFAB) at birth of African American origin during their reproductive years. The number of children that a person gives birth to can reduce their risk of having fibroids. This is because the uterus returns to its initial state after childbirth and can undergo a process of fibroid removal. Therefore, not giving birth exposes the uterus to potential fibroid growth.¹ 

Other factors that can have an impact on fibroid development include:

• Consumption of alcohol
• Smoking 
• Obesity
• Vitamin D deficiency 
• The use of oral contraceptives⁵ 

Influence of fibroids on the menstrual cycle 

Abnormal bleeding patterns 

Fibroids can impact your menstrual cycle. Their presence in the uterus can result in menorrhagia (heavy menstrual bleeding), menometrorrhagia (prolonged periods) and irregular menstrual cycles.⁶ This is attributed to the stimulation of blood vessels by fibroids. However, these bleeding patterns might not be solely due to the presence of fibroids. Instead, they could be indicative of other health conditions and ovulatory disorders, like endometriosis (when the endometrium grows in regions other than the uterus).⁶ Heavy bleeding during menstruation can result in secondary symptoms, such as iron-deficiency anaemia.  

Pain and discomfort during menstruation 

Pain and discomfort during menstruation could be a result of fibroids. While it is physiological to experience cramps during menstruation, the intensity of the pain can help determine if it is an indication of an abnormality. With fibroids, you may experience painful periods, clinically referred to as dysmenorrhea, and other accompanying symptoms, like pelvic pain and pelvic pressure.⁷ 

Changes in menstrual duration and frequency 

Fibroids can also cause your menstrual cycle to fluctuate, making it shorter or longer in duration. Fibroid can also lead to abnormal bleeding on days when you should not be menstruating.⁸ 

Impact on fertility and reproductive health  

Difficulty conceiving (infertility)  

Presence of fibroids in your uterus can affect your chances of getting pregnant because these tumours alter the structure of the uterine wall. Thus, they make the transport of sperm cells and the process of zygote (fertilised egg) implantation more difficult.^9,10 Submucosal and intramural fibroids tend to affect fertility more than the subserosal fibroids. Hence, the location of the tumours in the uterus is directly related to the severity of their impact on fertility.⁹ Research has also shown improved fertility in people AFAB after the surgical removal of submucosal and intramural fibroids. 

Pregnancy complications related to fibroids 

Complications during pregnancy are linked to certain gynaecological conditions, including fibroids. Miscarriages, preterm delivery, and placental issues can result from these tumours. Fibroids can disrupt implantation of a fertilised egg due to increased contractions of the uterus, abnormal blood supply, and inflammation of the uterus. When the placenta forms in close proximity to fibroids, this can lead to bleeding in the early stages of pregnancy. Fibroids can also cause the placenta to relocate to the lower part of the uterus, causing it to cover the cervix (known as placenta previa).  

Diagnosis and treatment  

Diagnosis 

Fibroids can be diagnosed based on the symptoms you present. While it is possible to be asymptomatic, the presence of fibroids can be detected through pelvic examination during gynaecological check-ups.¹² Most fibroids are usually detected by transvaginal ultrasonography. It is a non-invasive, economical and painless procedure that examines the uterine cavity. Although research shows that it has a high sensitivity and specificity, it is still a possibility that this procedure fails to detect small fibroids.¹¹ If bigger fibroids are present, an MRI  can also be used to get a more accurate view of the uterine cavity. In cases when submucosal fibroids are suspected, hysteroscopy is usually used.¹²

Treatment options 

The treatment of fibroids depends on the size and location of the tumours in the uterine cavity. Typical treatment options include:^13,16

• GnRH to decrease the tumour size
• Oral contraceptives 
• NSAIDs to prevent blood loss
• Surgery where a device is inserted into the uterus in order to constantly release a specific hormone that prevents pregnancy (levonorgestrel releasing intra-uterine system)
• Tranexamic acid

Surgical therapies include:^17,19

• Hysterectomy, which is the surgical removal of the uterus for people AFAB who do not intend to preserve their fertility 
• Myomectomy, which is the surgical removal of fibroids ​for people AFAB who intend to​ preserve their fertility 
• Uterine artery embolisation, which causes fibroids to shrink in size by blocking blood supply

Lifestyle and self-care strategies  

Eating fruits and vegetables and increasing vitamin D intake has been associated with a decreased risk of fibroids. Research shows that people AFAB that eat four servings of fruits per day are less likely to have fibroids compared to those who eat one serving or none at all.⁵ High fibre foods have also been recommended by experts.

It is important to also reduce the intake of foods that are rich in heavy metals, like lead and cadmium, which are usually found in seafood and leafy green vegetables.³ 

Exercise and physical activity can also be a form of stress management and relaxation that can help lower the risk of fibroids.

Seeking professional help and support  

Since fibroids can be asymptomatic, it is important to do your routine gynaecological check-ups and pay attention to unusual symptoms. Fibroids affect about 30% of people AFAB in the world.¹ If you have been diagnosed with fibroids, apart from treatment, you can check for local support groups as this can help you to network with other people you can safely share your experience with. Your healthcare provider will support you throughout and provide advice to improve your reproductive health.  

Summary  

Fibroids can cause irregularities in the length of your menstrual cycle and cause prolonged or heavy bleeding. It is important that you pay attention to your reproductive health and report to your physician if you experience any unusual symptoms. Early detection will enable your physician to take drastic steps on management of the disease. Visit your healthcare provider for routine check-ups, eat healthy foods and avoid diets that can increase your risk of having fibroids. After diagnosis, ensure you participate in the treatment options that have been suggested for you. Fibroids support groups are also available to support you.