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Submucosal Fibroid: Symptoms, Pregnancy, Treatment

Submucosal Fibroid Symptoms, Pregnancy, Treatment
There are four main types of fibroids: intramural fibroids, subserosal fibroids, submucosal fibroids, and pedunculated fibroids [1]. It’s important to understand that most women with uterine fibroids have more than one type of fibroid, which in turn can affect symptoms and treatment options.

Submucosal fibroids grow just underneath the uterine lining and can crowd into the uterine cavity, leading to heavy bleeding and other more serious complications. In this brief review, the fibroid specialists at ProFibroidMD explain submucosal fibroid symptoms, how submucosal fibroids can affect pregnancy, and what treatment options are available to women with submucosal fibroids. Read on to learn more.

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Fibroid Specialist Dr. Lalezarian provides submucosal fibroid treatment for patients in Los Angeles, California

Submucosal Fibroid
Relief in Los Angeles

ProFibroidMD is a leading provider of uterine fibroid embolization (UFE), the least invasive treatment option for submucosal uterine fibroid symptom relief. Our Fibroid Specialists have helped countless women overcome their fibroids and get back to their happy, healthy selves.
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“Absolutely awesome service from everyone I encountered! I had been suffering from severe pain from Fibroid issues, I had been offered hysterectomy from other doctors. I just wasn’t comfortable taking that route. I had my UFE at this location in April 2021 and I couldn’t be happier. My symptoms have dramatically decreased and I am ecstatic about my results! This procedure REALLY changed my quality of life and I am forever indebted.”

Dawn S, October 2021

Submucosal Fibroid Anatomy

Fibroid location is generally described relative to the three main layers of the uterus: the inner lining of the uterine cavity called the endometrium, the smooth muscle of the uterine wall called the myometrium, and the outer surface of the uterus known as the serous membrane.

A submucosal fibroid is a type of intramural fibroid where part of the fibroid projects into the uterine cavity and another part resides in the smooth muscle of the myometrium. According to the International Federation of Gynecology and Obstetrics (FIGO) classification system, there are two types of submucosal fibroids which are differentiated by how much of the fibroid extends into the uterine cavity vs. how much of it is intramural [2].

  • Fibroid Type 1: Submucosal, <50% intramural
  • Fibroid Type 2: Submucosal, ≥50% intramural
    • Diagram of submucosal fibroid within uterus
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    Submucosal Fibroid Symptoms

    Most cases of uterine fibroids do not cause noticeable symptoms. However, women that do experience submucosal fibroid symptoms will generally experience heavy menstrual bleeding and pain or pressure in the pelvic region. Women with submucosal fibroids can also experience bleeding in between menstrual cycles. This is especially common with prolapsed submucosal fibroids [3].

    Larger fibroids can sometimes exert pressure on surrounding organs and nerves, which can lead to more severe and noticeable symptoms, but larger fibroids aren’t always associated with more severe symptoms [4].

    Submucosal Fibroids and Pregnancy

    Women with submucosal fibroids may have problems with pregnancy or infertility, but fibroids generally aren’t considered as the source of infertility until other possible causes are ruled out. Because submucosal fibroids grow just underneath the uterine lining (the endometrium), they can crowd the uterine cavity and distort the shape of the endometrium, potentially causing complications. These abnormalities are thought to reduce embryo implantation and pregnancy rates for couples, including those using assisted reproductive technology to treat infertility.

    Many women with uterine fibroids are able to become pregnant and deliver their baby without a problem, but complications such as miscarriage, c-section, preterm labor and postpartum hemorrhage occur in approximately 10 to 40% of pregnancies when fibroids are present [5,6].

    Submucosal Fibroid Treatment

    Treatments for submucosal uterine fibroids vary from conservative medical therapy, to minimally invasive interventions, to surgical removal of the entire uterus. The optimal treatment for your submucosal fibroid 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 submucosal fibroid treatment option is best for you, and some treatment options are only viable for certain types of fibroids.
    Woman with submucosal uterine fibroids holding her stomach
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    Medications

    The most conservative treatment option for uterine fibroids 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, 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.

    Myolysis

    Myolysis is also called fibroid ablation. It uses a concentrated energy source such as ultrasound, radiofrequency, or laser to cause fibroid tissue destruction. MRI or ultrasound imaging help guide where the energy source should be directed. Myolysis decreases menstrual bleeding and uterine fibroid size [7]. However, it can only treat one fibroid at a time, and large fibroids greater than 8 cm in diameter may not respond well [9]. In addition, myolysis targets the central portion of the fibroids even though studies have shown that fibroids tend to grow from their peripheries [9].

    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].

    Endometrial Ablation

    In endometrial ablation, the lining of the uterus is destroyed. The fibroids themselves don’t necessarily shrink. Endometrial ablation helps decrease heavy menstrual bleeding and is most beneficial for women suffering from excessive bleeding due to fibroids [10]. Because endometrial ablation targets the inner lining of the uterus, it is most effective for submucosal fibroids [11-13]. In addition, endometrial ablation is most amenable for fibroids less than 3 cm in diameter.

    Pregnancy is not recommended after endometrial ablation. A single endometrial ablation procedure may require follow-up intervention in the future. A recent study compared the re-intervention rates for women after they underwent endometrial ablation, myomectomy, or uterine artery embolization to treat fibroids. One year after the initial procedure, the need for a second procedure was 12.4% for endometrial ablation, 4.2% for myomectomy, and 7.0% for uterine artery embolization [12,13].

    Myomectomy

    Myomectomy is considered a first-line conservative surgical therapy for symptomatic submucosal fibroids that are 4 to 5 cm in diameter [9]. Myomectomy is a surgery that involves selectively removing uterine fibroids while keeping the uterus intact. It is considered a major surgery that may require a blood transfusion and a 1 to 3 day hospital stay. Blood loss and operative time are greater for myomectomy than hysterectomy [9]. The recovery time for myomectomy can be quite long, ranging from 2 to 6 weeks.

    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

    A hysterectomy is a surgery where the entire uterus or parts of it are removed along with any fibroids. Hysterectomy can be performed through the vagina, abdomen or laparoscopically. Like myomectomy, hysterectomy is a major surgery requiring a 2 to 5 day overnight stay in the hospital and a long recovery time of 2 to 6 weeks [8].

    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.

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    Submucosal Fibroid Removal

    If you’re struggling with your submucosal fibroids, or are unsure of how to best treat them, get in touch with us at ProFibroidMD. We’ve helped thousands of women in Southern California find relief from their fibroids, and we may be able to help you.
    More Resources
    Woman discussing surgical vs. non-surgical fibroid treatment options with Fibroid Specialist

    Surgical vs. Non-Surgical Fibroid Treatments: Which Is Best?

    When it comes to fibroid treatment, we believe that less is more. A less invasive procedure means less trauma, less risk, and shorter recovery time. Learn more about why we opt for UFE, the least invasive treatment for uterine fibroids.

    Woman discussing surgical vs. non-surgical fibroid treatment options with Fibroid Specialist

    Uterine Artery Embolization

    Uterine artery embolization is a minimally-invasive procedure that we offer at ProFibroidMD to relieve heavy bleeding, pain, and other symptoms in patients with uterine fibroids. Learn more about our specialty procedure.
    Fibroid Specialist in Los Angeles

    Fibroid Specialist in Los Angeles

    Learn more about Los Angeles Fibroid Specialist Dr. Michael Lalezarian.

    References

    [1] Stewart, E. A. (2001). Uterine fibroids. The Lancet, 357(9252), 293–298.
    [2] Cook H, Ezzati M, Segars JH, McCarthy K. The impact of uterine leiomyomas on reproductive outcomes. Minerva Ginecol. 2010 Jun;62(3):225-36. PMID: 20595947; PMCID: PMC4120295.
    [3] Simms-Stewart D, Fletcher H. Counselling patients with uterine fibroids: a review of the management and complications. Obstet Gynecol Int. 2012;2012:539365. doi: 10.1155/2012/539365. Epub 2012 Jan 9. PMID: 22272207; PMCID: PMC3261489.
    [4] Lippman, Sheri & Warner, Marcella & Samuels, Steven & Olive, David & Vercellini, Paolo & Eskenazi, Brenda. (2004). Uterine fibroids and gynecologic pain symptoms in a population-based study. Fertility and sterility. 80. 1488-94. 10.1016/S0015-0282(03)02207-6.
    [5] Ouyang DW, Economy KE, Norwitz ER. Obstetric complications of fibroids. Obstet Gynecol Clin North Am. 2006; 33:153–69. [PubMed: 16504813]
    [6] Exacoustòs C, Rosati P. Ultrasound Diagnosis of Uterine Myomas and Complications in Pregnancy. Obstet Gynecol. 1993; 82:97–101. [PubMed: 8515934]
    [7] Mas A, Tarazona M, Dasí Carrasco J, Estaca G, Cristóbal I, Monleón J. Updated approaches for management of uterine fibroids. Int J Womens Health. 2017 Sep 5;9:607-617. doi: 10.2147/IJWH.S138982. PMID: 28919823; PMCID: PMC5592915.
    [8] Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Womens Health. 2014 Jan 29;6:95-114. doi: 10.2147/IJWH.S51083. PMID: 24511243; PMCID: PMC3914832.
    [9] Vilos GA, Allaire C, Laberge PY, Leyland N; SPECIAL CONTRIBUTORS. The management of uterine leiomyomas. J Obstet Gynaecol Can. 2015 Feb;37(2):157-178. doi: 10.1016/S1701-2163(15)30338-8. PMID: 25767949.
    [10] Stewart, E.A., Laughlin-Tommaso, S.K. Patient education: Uterine fibroids (Beyond the Basics). UpToDate. Accessed February 2021.
    [11] Singh SS, Belland L. Contemporary management of uterine fibroids: focus on emerging medical treatments. Curr Med Res Opin. 2015;31(1):1-12.
    [12] Davis MR, Soliman AM, Castelli-haley J, Snabes MC, Surrey ES. Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with Uterine Fibroids. J Womens Health (Larchmt). 2018;27(10):1204-1214.
    [13] Munro MG. Endometrial ablation: where have we been? Where are we going?. Clin Obstet Gynecol. 2006;49(4):736-66.

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