Submucosal Fibroids

Uterine fibroids are benign or non-cancerous tumors found in the muscular wall of the uterus, occurring in 30-40 percent of women of childbearing age. Most women with fibroid tumors may not experience any symptoms. They manage to perform their daily activities as well as maintain a good quality of life. In some women, the symptoms of uterine fibroids are so severe that they affect their ability to maintain their day-to-day activities. Based on where they grow, doctors have put fibroids into three groups: subserosal fibroids, intramural fibroids and submucosal fibroids.

What are Submucosal Fibroids?

The fibroids that develop in the submucosal layer, that is, the inner side of the uterus are called submucosal or subendometrial fibroids. These uterine fibroids usually originate as intramural fibroids, meaning between the muscles of the uterus, and gradually grow towards the endometrial cavity. Sometimes submucosal fibroids may be attached to the uterus by means of a long stalk. Such fibroids tumors are called pedunculated submucosal fibroids.

These stalked fibroids may appear to be similar to pedunculated subserosal fibroids due to the presence of the stalk, but the similarity ends at this point. While submucosal fibroids are confined to the inner layer of the uterus and the endometrial cavity, subserosal fibroids are found only on the outer surface of the uterus.

Another point of difference between submucosal fibroids and the other two types of fibroids is the prevalence. Whilst intramural and subserosal fibroids are common, found in 70 percent and 20 percent of women of reproductive age respectively, submucosal fibroids are rare, accounting for only 5 percent of all occurrences of fibroids among women.

What are the Symptoms of Submucosal Fibroids?

Most women don’t even know that they have uterine fibroids. However, in some women, the presence of submucosal fibroids is quite symptomatic, particularly those who have either multiple or large subendometrial fibroids. Some typical symptoms are:

• Unusually heavy or prolonged menstrual periods
• Severe abdominal cramps during menstrual periods
• Bleeding between menstrual periods
• Postmenopausal bleeding
• Pelvic pain
• Back pain
• Large submucosal fibroids can cause some discomfort in the lower abdomen
• Severe pain, if the stalk of the pedunculate submucosal fibroid twists or if the uterine fibroid outgrows its blood supplies

Can Submucosal Fibroids Cause Infertility?

Submucosal fibroids are known to cause infertility in women of childbearing age. There are several ways in which submucosal fibroids can induce infertility. For instance, they can block the fallopian tube, thus preventing sperm from fertilizing the egg. Large submucosal uterine fibroids may increase the size of the uterus’ cavity. An enlarged cavity increases the distance that sperm have to travel.

These fibroids may have a severe impact on the uterus’ ability to contract, which in turn can interfere with sperm migration and ovum transport. Multiple and large submucosal fibroid tumors can distort the uterus’ cavity, impair the blood supply to the endometrium and disturb the structure of the endometrium through thinning, ulceration, hyperplasia, inflammation or atrophy. In a nutshell, the entire anatomy of the uterus is disturbed and, even if the sperm is able to fertilize an egg, the chances of implantation are drastically reduced.

The presence of submucosal fibroids during pregnancy can lead to pregnancy complications. During the course of pregnancy, these fibroids will also grow in size, thereby decreasing the amount of space available for the baby to grow. As a result, either miscarriage or foetal congenital deformities can occur. Furthermore, submucosal fibroids can increase the chances of postpartum hemorrhage, obstructed labour, stalled labour and cesarean section.

Can Submucosal Fibroids be Treated?

There is no drug treatment that can cure submucosal fibroids permanently. Medicine can provide only temporary relief to the symptoms. Surgical treatment is still considered the best option with respect to submucosal fibroids. Hysteroscopy and submucus resection, which is performed through the vagina, is found to be quite effective for the treatment of symptomatic submucosal fibroids. Laparoscopic method and myolysis is useful for treating pedunculated submucosal fibroids.

Uterine artery embolization is another method used for the treatment of symptomatic fibroids. Another popular method for the treatment of submucosal fibroids is hysterectomy, that is, the removal of the uterus with or without the removal of the cervix. Doctors opt for this method only if the fibroids cannot be managed by other means and the patient is done with child bearing.