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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Submucosal Fibroid
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Dawn S, October 2021
Submucosal Fibroid Anatomy
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].
Submucosal Fibroid Symptoms
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
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
Medications
Uterine Fibroid Embolization
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].
Endometrial Ablation
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 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.
Submucosal Fibroid Removal
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.
Uterine Artery Embolization
Fibroid Specialist in Los Angeles
Learn more about Los Angeles Fibroid Specialist Dr. Michael Lalezarian.
[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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