Types Of Fibroids

Fibroids are growths in the muscular walls of the uterus. These are made up of connective tissue and muscle cells. Fibroids can develop as a single nodule or in clusters of several. The size can vary enormously from as small as 1mm across to 20cm or larger.

* Intramural Fibroids-These are the most common type and grow inside the uterus wall

* Subserosal Fibroids-These grow in an outward direction from the outside layer of the uterus towards the abdominal cavity

* Submucosal Fibroids-These grow inwards from the uterine wall into the endrometrial cavity

Occasionally, fibroids are joined to the uterus by a stalk. These are known as pedunculated fibroids.

On the image below you can see how and where these different types of fibroids might grow. Each type of fibroid has a detailed explanation below.

Intramural fibroids are the most common type of fibroids and develop within the wall of the uterus. They always begin life as small nodules, expanding inwards as time goes on. This can cause distortion of the uterine cavity. Occasionally, intramural fibroids mght grow towards the emdrometrial cavity thus becoming submucosal fibroids. Rarely, they may grow towards the outer suface of the uterus, becoming subserosal fibroids.

Symptoms

Very often you will not even be aware that you have intramural fibroids. If they do cause symptoms, you may have one or more of the following:-

* Heavy periods
* Back pain
* Bloating and constipation
* Pain in the pelvic area
* Constant urge to urinate
* Pain in the backs of the legs
* Swollen/enlarged abdomen
* Discomfort or pain during intercourse (depending on the location of the fibroids)

Infertility

In most cases, fertility is not affected. However, in around 3% or cases, intramural fibroids are linked with infertility. The greater the number of fibroids you have and the larger they are, the more likely it is that fertility will be affected.

These types of fibroids can stop sperm from entering the uterus, particularly when the fibroids are very near to the cervix. If the fibroids are very large, they can cause the uterus to enlarge, thus increasing the distance which the sperm have to travel to reach the fallopian tubes. If fertilization takes place, implantation of the embryo could be a problem as intramural fibroids can inhibit the blood supply to the lining of the womb. Even when implantation has occured, the fibroids could interfere with the normal development of the foetus.

Intramural fibroids normally enlarge along with the growng pregnancy and space may be a problem. This can occasionally cause developmental defects or could even cause a miscarriage.

Treatment

If intramural fibroids are not causing any symptoms and are not interfering with a woman's wish to get pregnant, it is likely that they will be left alone. However, if they are large or causing unpleasant symptoms, then treatment might be necessary.

Surgery is an option for treating fibroids and there are three main types of procedures which can be considered.

1. Removal of one or more fibroids by a procedure called abdominal myectomy
2. Desruction of the fibroids by uterine artery embolization, where plastic beads are injected into the artery supplying blood to the fibroid, blocking the supply.
3. The complete removal of the uterus by hysterectomy.

There is no effective drug treatment for the removal of fibroids. However, hormonal treatment is sometimes used to shrink the fibroids prior to surgery but this can not be continued for periods of more than a few months due to unwanted side effects.

Subserosal fibroids grow on the outer surface of the uterus and grow outwards, giving a lumpy appearance. Occasionally, these types of fibroids may be connected to the uterus with a stalk. These types are called pedunculated subserosal fibroids. In some ways they appear similar to ovarian cysts and it can be difficult to distinguish between the two due to similarities in appearance and location.

Although subserosal fibroids can grow quite large, they do not usually affect the shape of the uerine cavity. They are very common amongst women of reproductive age.

Symptoms

Most women will experience no symptoms from subserosal fibroids although women with pedunculated fibroids may experience the following:-

* Back pain
* Pain in the pelvis
* Frequent urination
* Bloating and constipation
* A feeling of heaviness and/or pressure in the abdomen
* Abdominal pain and cramps
* Kidney damage due to the pressure placed on the tubes leading to/from the kidneys
* The stalks of pedunculated subserosal fibroids can occasionally twist around and cause pain

Infertility

Large pedunculated subserosal fibroids can have an effect on fertility and pregnancy. Sometimes the location can mean that they are pressing against the fallopian tubes and this can inhibit the passage of sperm. Alternatively, the pelvic cavity can be so distorted that the fallopian tube cannot collect the egg. The result of both of these scenarios is infertility.

Once a pregnancy is achieved, as fibroids often grow during pregnancy, the uterus can become crowded. This can cause development issues for the fetus and can cause complications in pregnancy and difficulties in labour.

Treatment

The normal surgical treatment for subserosal fibroids is removal by laproscopy. Due to their location on the outer surface of the uterus, they are effectively removed one at a time. Any medical/drug treatment is only a temporary measure and will only help alleviate the symptoms.

Submucosal fibroids develop in the inner side of the uterus and usually start life as intramural fibroids. As they enlarge, they tend to grow inwards towards the endrometrial cavity. Occasionally they may be attached by a stalk and in these cases are called pedunculated submucosal fibroids. Although similar to subserosal fibroids due to the stalk, this type only ever appear inside the uterus. Submucosal fibroids are much rarer than the other types and only account for 5% of fibroids.

Symptoms

Submucosal fibroids do not usually produce any symptoms. However, the larger the fibroids and the greater in number, the more likely a woman is to experience some of the following symptoms:-

* Severe abdominal cramps during periods
* Heavy or prolonged periods
* Bleeding between periods
* Bleeding after the menopause
* Pain in the pelvis
* Back pain
* Mild pain/discomfort in the lower abdomen
* If the stalk twists, then severe pain can be the result. In addition, pain can also occur if the fibroid outgrows its blood supply

Infertility

Submucosal fibroids can cause fertility problems for several reasons. They can cause blockages in the fallopian tube and prevent the sperm from reaching the egg. Large fibroids of this type can extend the size of the uterus making the distance which the sperm has to travel much greater. Submucosal fibroids can also inhibit the ability of the uterus to contract and this can have an impact on sperm migration and the transportation of the egg. Large fibroids can also have a detrimental effect on the blood supply of the uterus and this can cause thinning, ulceration or inflammation of the lining. This can have a catastrophic effect on the ability of a fertilized egg to implant itself.

During pregnancy, submucosal fibroids can cause complications. As the pregnancy progresses, the fibroids will grow and reduce the available space for the growing baby. This can increase the chance of miscarriage or deformities. In addition, submucosal fibroids can increase the likelihood of bleeding, obstruction during labor, prolonged labor and cesarian section.

Treatment

Can Submucosal Fibroids be Treated?

Drug treatment is purely symptomatic and cannot be taken permanently. Once stopped, the symptoms will return. Surgical treatment is very common if the fibroids are causing severe problems. Surgery to remove the fibroids can be performed throught the vagina or alternatively, laproscopy and myolysis may be used. Uterine artery embolization is another method which can destroy the fibroids, leaving the womb intact. Hysterectomy is also an option for submucosal fibroids.