By: Jean Johnson for Fibroids1Part 2: Subserosal and Submucosal Fibroids Part One
In the first part of this series, we discussed female reproductive anatomy and intramural fibroids. Now in this second installation we will clarify two other common types of uterine fibroids, called subserosal and submucosal. Ideally, you’ll find the material empowering and something you can print and take in to your physician’s office.
Subserosal Uterine Fibroids
Subserosal (sub-ser-O-sal) fibroids grow near the outer covering of the uterus under a thin membrane called the serosa. They often produce no symptoms in women, but can become quite large and extend out into the abdominal cavity on a stalk-like appendage called a peduncle (thus, a pedunculated fibroid).
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If you notice any of the following symptoms, you do not have to suffer. Call your doctor because you may have fibroids.
Heavy, prolonged menstrual periods with spotting in between
Cramping
Bloating and a feeling of heaviness in the lower abdomen
Frequent urination
Constipation
Pain or discomfort with sexual intercourse |
Because subserosal fibroids are located on the outer surface of the uterus, they generally do not cause heavy bleeding. Nonetheless, masses that become large and pedunculated can make their presence known by a generalized feeling of heaviness as well other symptoms including pelvic and back pain, constipation, frequent urination, and bloating.Although subserosal fibroids are not associated with infertility, if large enough and in the right location, they can interfere with a female’s normal reproductive system. These types of fibroids can press on the fallopian tubes, interfering with normal ovulation, and can cause complications if they grow right next to a fetus.
The preferred method of treatment for this type of fibroid is a minimally invasive laparoscopic myomectomy. Through a small incision in the naval, a laparoscope is placed in the abdomen. Then, the surgeon dissects and removes the fibroids one small piece at a time.
Submucosal Fibroids
This category is rare, making up only about five percent of all fibroids. When submucosal fibroids – which grow within the mucosa, or the inner lining of the uterus – are present, however, their symptoms can be quite pronounced.
Submucosal fibroids can grow large and cause symptoms like extended heavy periods, bleeding between periods, abdominal cramping, and back pain. Because they tend to grow toward the interior of the uterus and can develop a long pedunculated stalk like subserosal fibroids, submucosal fibroids are known to cause infertility in women of childbearing age. Compression of the fallopian tubes or distension of the uterus can prevent sperm from reaching an egg. Furthermore, these types of fibroids can grow large and rob blood supply to the endometrium (uterine lining), on which a healthy pregnancy depends.
Since submucosal fibroids reside within the interior of the uterus, removing them vaginally via a hysteroscopy is often the treatment of choice. If the fibroids are pedunculated however, a laparoscopic myomectomy is often the most effective approach. Uterine fibroid embolization and hysterectomy are also options for women.
Further Considerations About Fibroids
Cancer
Available research states that cancer risk with fibroids is virtually nil. If a fibroid starts to grow rapidly, gynecologists may become concerned and recommend surgical removal, but they become cancerous in only one-tenth of one percent of the population.
Regrowth
With the exception of a hysterectomy, there is a possibility that the fibroids will grow back. Women who are treated after menopause have a lower chance of recurrence because estrogen levels naturally drop.
Be confident and discuss concerns with your health care provider. Don’t be afraid to seek a second opinion if you feel your questions are not being fully addressed.
Diagnostic Tests
Endometrial biopsies, relatively painless procedures done in a clinician’s office, can help identify the source of abnormal bleeding. A uterine ultrasound, which uses sound waves via a transducer probe and is either swept across the belly or inserted vaginally, can also aid in diagnosis.
For better visual images, some gynecologists will use hysterosonography. Sterile saline is injected into the uterus to detect fibroids; the saline can cause mild to moderate cramping.
The last test that a clinician can do in his or her office is a diagnostic hysteroscopy. Local anesthesia is required and saline or CO2 gas is used to inflate the uterine cavity, thus providing images of the anatomy on a monitor.
Magnetic resonance imaging, or MRI, has come to the forefront as a preferred way to get the clearest pictures of the uterus. Most if not all interventional radiologists rely on MRIs before they move ahead with uterine fibroid embolization. Surgeons also find that MRIs are helpful prior to the major abdominal surgery required for a myomectomy or hysterectomy.
