Episode 10 - Uterine fibroids, polyps and infertility - Dr I-Ferne Tan
Fibroids, polyps and fertility: a guide for GPs
Heavy periods, pelvic discomfort and difficulty conceiving can bring patients to their GP long before they see a fertility specialist. An ultrasound may identify a fibroid or endometrial polyp, but the next question is often less straightforward: does this finding need treatment, and what does it mean for the patient's plans for pregnancy?
In this episode of Fertility in General Practice, host Dr Ali Hodgkinson speaks with Dr I-Ferne Tan about uterine fibroids, endometrial polyps and their relationship with fertility. They discuss symptoms, assessment, treatment choices and how to match a referral to the patient's needs rather than the imaging finding alone.
Understanding the difference
Fibroids and polyps are not the same condition. Fibroids arise from the muscular tissue of the uterus, while endometrial polyps develop from its lining. Their size, position and effect on the uterine cavity can vary, so a shared label does not mean every patient will have the same symptoms or need the same treatment.
Dr Tan explains why the location of a fibroid is particularly relevant when considering fertility. The relationship with the uterine cavity, alongside symptoms and the wider fertility assessment, helps determine whether an intervention should be discussed. A small incidental finding may raise different questions from a lesion associated with substantial bleeding or a change in the cavity.
Looking beyond the ultrasound report
A useful assessment brings together bleeding patterns, pain or pressure symptoms, reproductive history and the patient's goals. Someone who wants to conceive soon may need a different plan from someone who is not considering pregnancy for several years.
The episode explores why a finding does not automatically mean an operation is required. Some patients can be monitored, while others need further assessment or treatment. GPs can help by recording how symptoms affect everyday life, whether pregnancy is a current priority and what investigations have already been completed.
Changes in bleeding or other concerning features should be assessed in their own right. Patients should not assume every symptom can be explained by a previously identified fibroid or polyp without review.
Balancing symptom relief and fertility plans
Dr Tan discusses the distinction between managing symptoms and treating a structural problem in someone trying to conceive. Some medical options for heavy bleeding are hormonal and may also act as contraception. That makes the patient's reproductive plans an essential part of the treatment conversation.
Surgery also needs to be timed thoughtfully. The episode considers the possibility of fibroid recurrence and the balance between treating symptoms now and planning for future fertility. There is no single timetable that suits everyone. The decision should account for the size and location of the fibroids, the likely procedure, recovery and other fertility considerations.
What hysteroscopy can offer
Hysteroscopy allows a clinician to look inside the uterus using a thin camera passed through the vagina and cervix. It can be used to assess the uterine cavity and, where appropriate, treat conditions such as endometrial polyps.
Dr Tan describes office-based, awake hysteroscopy as an option for selected patients. For someone worried about a general anaesthetic or the disruption of a hospital procedure, understanding whether this approach is suitable may be valuable. Suitability, comfort, pain management and the nature of the planned treatment need to be discussed individually. An office procedure is an option to explore, not a promise that every patient can or should have the same experience.
Choosing the right referral pathway
A patient's main concern can help guide the referral. Significant bleeding, pressure symptoms, an uncertain diagnosis or fertility difficulties may call for different expertise or a combined approach. Dr Tan encourages attention to the person's priorities, including preferences about anaesthesia and future pregnancy.
For a patient already likely to need assisted reproduction, a fertility specialist who can assess the uterine finding alongside other factors may help coordinate care. For GPs, sharing the ultrasound report, symptom history and pregnancy plans can make the first specialist appointment more useful and reduce unnecessary repetition.
Listen to the episode
Listen to Dr I-Ferne Tan and Dr Ali Hodgkinson discuss how to interpret common uterine findings, explain treatment options and support patients making decisions about symptoms and fertility. The conversation keeps the focus on individual assessment rather than treating every fibroid or polyp in the same way.
About Dr I-Ferne Tan
Dr I-Ferne Tan is a fertility specialist and gynaecologist with training in reproductive surgery and infertility medicine. Her clinical interests include period disorders, pelvic pain, abnormal bleeding, endometriosis-related fertility concerns and unexplained infertility. She holds a Master of Reproductive Medicine and completed international fellowship training in minimally invasive surgery. At Genea, she combines surgical and non-surgical options with clear explanations and care tailored to each patient's goals.
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