London Women’s Clinic’s Dr Barbara Manukian explains what you need to know about this pressing topic in reproductive healthcare
BY ELLA GAUCI, IMAGE BY DIVERSIFYLENS
Fibroids are astonishingly common. So common, in fact, that research suggests eight out of 10 Black women will develop them in their lifetime. That figure alone sets Black women apart as one of the most disproportionately affected groups in the landscape of reproductive health. And yet, the “why” remains frustratingly elusive. Scientists point to a constellation of factors – including higher rates of vitamin D deficiency or stress – but the full picture is still unsettled.
Fibroids can be disruptive, painful and – critically – in a third of cases, they appear alongside infertility. To untangle some of the pressing questions around fibroids and fertility, DIVA spoke with Dr Barbara Manukian, clinical lead at the London Women’s Clinic, about the fertility options available for Black people living with, or worried about, fibroids.
What is a fibroid and what symptoms should people with uteruses look out for?
Simply put, a fibroid is a non-cancerous pelvic tumour that develops in or around the uterus. These growths are made up of muscle and fibrous tissue. Fibroids can be symptomatic or asymptomatic. In some instances, the symptoms can be severe, affecting the patients’ quality of life. The most common symptoms are chronic pelvic pain and heavy periods.
How do fibroids impact fertility?
They distort the typical anatomy of the uterus, potentially causing blockage or distortion of the cervix, fallopian tubes or endometrial cavity. When fibroids are impacting the endometrial lining (called submucosal), there is a decrease in pregnancy rates, implantations or live births.
Unfortunately, people with fibroids might have lower success rates when doing fertility treatments. If the fibroids are distorting the endometrium, they can decrease implantation rates or cause miscarriages. Occasionally, they can block the access to the ovaries during the oocyte retrievals in an IVF cycle.
What fertility options are there out there for people who have fibroids?
Some patients whose daily life is affected may need to have their uterus removed (hysterectomy) or get other medical treatments, but these are not recommended for patients who want to get pregnant. If the patient wants to get pregnant, they might choose to have only the fibroids removed, a surgery called myomectomy.
Are there misconceptions about fibroids that you’d like to clear up – especially for Black women and non-binary people who may already feel unheard by the healthcare system?
When you mention the word fibroids, everyone gets scared. However, it’s not the case that if you have a fibroid, you will have problems. The problems from the fibroids depend on the size, the location, and what the patient wishes to do. Having a fibroid doesn’t always mean you have a problem.
For someone who has had fibroid surgery, what should they know about their fertility outlook?
Surgery these days is very safe. We operate on fibroids very often. Sometimes you need a less invasive surgery, which is called hysteroscopy. That’s when you go through the vagina, inside the womb, remove the fibroid and take it away. Sometimes the patients need surgeries that are more invasive. The main risk is the bleeding and infection that the patient might have. That bleeding can be so large that patients end up needing a hysterectomy, which is when they remove the uterus. Most surgeries go well and have no consequences for a patient’s fertility. But if a complication happens – like bleeding or scar tissue – it can affect pregnancies. The best idea is to try and conceive as soon as you can after you have recovered because fibroids can come back.
What advice would you give to people who are concerned about fibroids?
It’s always scary when you go to a fertility clinic, regardless of what you’re coming for. Some people delay this consultation for so long in case there is a problem. That is the opposite of what you should do. Be proactive and have a consultation earlier so you can be prepared for your journey in the future. Try to be open-minded.
Find out more at: londonwomensclinic.com
To celebrate Black History Month, London Women’s Clinic is hosting a free webinar about fertility and reproductive health in the Black community.
You can sign up today!
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