Anemia, infertility, and other risks of delaying fibroid treatment

This content is sponsored by The Center for Innovative GYN Care

Fibroids are a common GYN condition that affect more than 80 percent of women by age 50. Many women with fibroids have no symptoms, but for those who experience heavy bleeding, pelvic pain, or bloating, treating fibroids as soon as possible can be crucial.

Ignoring the symptoms of fibroids can lead to long-term complications, including anemia, infertility and problems with the bowel, bladder or circulatory systems.

  • Anemia can result from excessive blood loss. Anemia is the result of deficiencies in the blood, or the body’s inability to produce enough red blood cells. Anemia can cause fatigue, weakness, shortness of breath, heart problems and headaches.
  • Infertility can be caused by the location of fibroids or by a fibroid growing simultaneously with a pregnancy, fighting for space and blood supply.
  • Kidney damage, or nephrosis, can be the result of fibroids pressing against the ureter, blocking the drainage of urine into the bladder from the kidneys.
  • Bowel, bladder or circulatory problems may result from large fibroids taking over space in the pelvic cavity, blocking the normal flow of these systems.

Despite the risks, there are several reasons women ignore heavy bleeding or pelvic pain.

  • The normalization of period-related discomforts can lead women to dismiss symptoms as something they have to simply live with. When symptoms move from discomfort into something more disruptive, it’s time to consult a specialist.
  • OBGYNs advise patients to wait on treatment. Watching and waiting to treat fibroids has become a standard practice of OBGYNs when patients report problems. This watch and wait advice often leads to fibroids growing, increased bleeding, bloating, pelvic pain, and the risk of the complications listed above.


Watching and waiting to treat fibroids is an out-of-date practice. Treating fibroids early is important for preserving fertility, as well as for treating the source of anemia. Laparoscopic myomectomy is the preferred approach for treating fibroids while maintaining fertility. For many OBGYNs, the difficulty in treating fibroids effectively is due to the lack of advanced skills required to perform laparoscopic removal, either as a myomectomy or a hysterectomy.

Patient volume matters to ensure laparoscopic fibroid procedures are performed with expertise. In many cases, OBGYNs have a low volume of surgeries that are performed each year, and as a result, only perform open procedures.

Due to the large incisions and long recovery times, OBGYNs who are only able to perform open surgery will often encourage the watch and wait approach, delaying treatment because of the possible risks to the patient. Similarly, physicians with limited laparoscopic training who use robotics to perform these procedures often do not have the patient volume to develop the skills needed for an effective and thorough surgery. In some cases, there is the risk of a robotic fibroid removal procedure converting to an open procedure, leaving the patient with a longer recovery time and more pain.

It is essential that women who are suffering from fibroids and who are told either to watch and wait, or that their only options for surgery are open or robotic, need to get a second opinion.


There are many non-surgical treatments for fibroids available, but the limitations of these treatments in preserving fertility is not well understood. Uterine Fibroid or Artery Embolization (UFE or UAE), or fibroid ablation procedures are not recommended for women who want to get pregnant. Women should thoroughly research these methods, when choosing fibroid treatment.


If fibroids are left behind, either due to them being missed, or due to a surgical procedure having to be terminated early due to excessive blood loss, they can continue to grow, and symptoms may persist.

Thoroughly removing fibroids from the uterus should only be performed by a highly skilled minimally invasive GYN surgeon. Fibroids that are deep in the muscle or are very small can be hard to find unless they are felt and removed by hand. Unless all of the fibroids are removed, they can continue to grow, and cause problems with heavy bleeding, pelvic pain and infertility. Standard laparoscopic or robotic techniques do not allow a surgeon to feel the fibroids, and often, those that are left behind become problematic.

Fibroid removal surgery can be performed as a myomectomy, removing the fibroids from the uterus, or as a hysterectomy, removing the uterus itself. A myomectomy is performed for women who are able to maintain fertility. A hysterectomy for fibroid removal is performed for women who no longer wish to get pregnant, and who suffer from recurring fibroids. It is important to find a surgeon who will take future plans for fertility into consideration.


“Uterine fibroids can be unpredictable,” said Paul MacKoul, MD. “They can continue to grow, and in some cases grow very large, very fast. Removing them when they are smaller can help preserve a woman’s fertility but will also result in a faster recovery for the patient. The larger the fibroid, the more damage to the uterus.”

The advanced-trained minimally invasive GYN specialists at CICG developed the LAAM myomectomy for fertility and the DualPortGYN hysterectomy.

A delicate procedure like a myomectomy requires the ability to feel in order to create the best possible result. A successful myomectomy requires the surgeon to remove fibroids often deep in the muscle of the uterus that cannot be easily seen. It also requires the surgeon to remove all the fibroids, including smaller ones, which can only be located by feeling them. LAAM is a minimally invasive fibroid removal technique that allows the surgeon to feel all of the fibroids at any location in or around the uterus and allows for their safe and effective removal no matter the size.

“The CIGC LAAM fibroid removal is a state-of-the-art myomectomy technique that has helped thousands of women with very small to very large fibroids,” said Natalya Danilyants, MD.  “Unfortunately, too many patients with fibroids are told to wait and see if they shrink, so that by the time they come to us the fibroids are often huge. OBGYNs particularly need to think about what the patient is experiencing with these conditions. Larger fibroids can require more complicated surgery and have a greater impact on fertility.”

A DualPortGYN hysterectomy is one of the most minimally invasive GYN surgery techniques available. A hysterectomy is the most effective way to eliminate fibroids. Once the uterus is removed, fibroids cannot regrow. It is important to understand what a hysterectomy entails, and to choose a skilled minimally invasive GYN surgeon who will explain in detail what will happen during and after the surgery.

CIGC is dedicated to providing information and materials for women to help navigate the complicated healthcare system. CIGC minimally invasive GYN surgical specialists Dr. Paul MacKoul, MD and Dr. Natalya Danilyants, MD developed their advanced GYN surgical techniques using only two small incisions with patients’ well-being in mind. Book a consultation at The Center for Innovative GYN Care or call 888-787-4379.

More from WTOP

Log in to your WTOP account for notifications and alerts customized for you.

Sign up