Pedunculated Fibroid: Symptoms, Pregnancy, Treatment

• Fibroid Type 0: Pedunculated, intracavitary
• Fibroid Type 7: Subserosal, pedunculated

Many women with uterine fibroids are able to become pregnant without a problem. However, certain types of fibroids, including pedunculated fibroids can crowd the uterine cavity or distort the endometrium, causing pregnancy complications. Some studies show that the risk of developing complications during pregnancy increases if a woman has uterine fibroids over 3 cm in diameter. In general, complications such as miscarriage, c-section, preterm labor and postpartum hemorrhage can occur in approximately 10 to 40% of pregnancies when fibroids are present [10, 11].

Pedunculated fibroid treatment varies from conservative medical therapy, to minimally invasive interventions, to surgical removal of the entire uterus. The optimal pedunculated fibroid treatment for you will depend on your desire to preserve fertility, your age, any other existing medical issues, ability to take time off for recovery, as well as other factors. Some therapies treat symptoms while others eliminate the fibroids completely. Some treatment options, while less invasive, may require subsequent treatment or re-intervention. These are all factors to consider when deciding which pedunculated fibroid treatment option is best for you, and some treatment options are only viable for certain types of fibroids.

Medications

The most conservative pedunculated fibroid treatment option is medical therapy. Medicine can be effective if symptoms are mild, if a woman is in perimenopause (so treatment is only needed in the short term), or if pre-operative intervention to reduce the size of the fibroids would make a surgery less technically challenging [7, 8]. Nonsteroidal anti-inflammatory drugs (NSAIDs), hormones (estroprogestins or progestogens), and oral contraceptives can help with symptomatic bleeding and fibroid pain. Gn-RH analogues and selective progesterone receptor modulators (sPRMs) like ulipristal acetate (UPA) help treat bulk symptoms such as pelvic pressure, pelvic pain, and frequent urination [9]. Medical treatments are only used for the short-term due to the significant health risks associated with long-term use of these medicines [7].

Uterine Fibroid Embolization

Uterine fibroid embolization (UFE), also known as uterine artery embolization, is a minimally invasive procedure performed by an interventional radiologist or vascular specialist. During the procedure, small spherical beads are injected into the blood vessels that supply the fibroids with oxygen and other nutrients. The beads occlude the blood vessels, essentially starving the fibroids and causing them to shrink. UFE is an outpatient procedure with a recovery time around 1 to 2 weeks.

Uterine fibroid embolization is a viable pedunculated fibroid treatment option, however pedunculated fibroids with a narrow stem (diameter less than 50% of the diameter of the largest fibroid) are considered to be relative contraindications for UFE because these fibroids may detach into the peritoneal or uterine cavities and cause infection [14].

Myolysis

Myolysis does impact future fertility and pregnancies. As fibroid tissue is destroyed with myolysis, scar tissue can form in the endometrium. While some women may achieve successful pregnancies, there could be potential complications. Myolysis is not always a definitive treatment. Surgical intervention may be required down the line [7].

Myomectomy

Myomectomy isn’t without its shortcomings, and isn’t always ideal for women with multiple large fibroids. Failure rates range from 14.5% to 30% at 3 to 4 years’ follow-up [9]. Between 10 and 25 percent of women will require a second fibroid surgery [10]. Still, many women choose myomectomy in order to preserve their uterus for future pregnancies. Most women who have myomectomy are able to have children afterwards.

Hysterectomy

Hysterectomy is the most definitive treatment available for uterine fibroids, particularly for women who have no desire to conceive [7]. It can be very effective for patients with extremely large fibroids or a large quantity of fibroids. However, after hysterectomy, once the uterus or parts of it are removed, pregnancy is no longer possible.