Uterine fibroids (leiomyomas) are common, non-cancerous growths originating from the smooth muscle tissue of the uterus. These tumors vary widely in size and number, classified by their location within the uterine wall. The fibroid’s location dictates the type and severity of symptoms, with the submucosal type often causing the most disruptive health issues.
Defining Submucosal Fibroids
Submucosal fibroids develop directly beneath the endometrium, the inner lining of the uterus. This placement causes the growth to protrude into the uterine cavity, often distorting its shape. Because of this location, submucosal fibroids are the type most likely to cause significant symptoms, even when small.
Classification is refined based on how much of the fibroid is contained within the uterine muscle wall. Type 0 fibroids are entirely within the uterine cavity, often attached by a stalk. Type 1 fibroids have less than 50% of their mass extending into the muscle layer. Type 2 fibroids, conversely, have 50% or more of their mass embedded within the muscle, representing a more challenging surgical presentation.
Recognizing the Signs
The primary symptom associated with submucosal fibroids is heavy and prolonged menstrual bleeding (menorrhagia), as their presence disrupts the normal shedding of the endometrial lining. This excessive blood loss often results in iron-deficiency anemia, which manifests as persistent fatigue, weakness, and dizziness. Individuals may also pass frequent or unusually large blood clots during their menstrual cycles, an indication of the severity of the bleeding.
The distortion of the uterine cavity caused by the fibroid’s protrusion can also lead to other forms of pelvic discomfort. Patients frequently report severe menstrual cramping, a dull ache, or a feeling of pressure in the lower abdomen or lower back. This specific type of fibroid significantly impacts reproductive health, as the growths can interfere with the implantation of a fertilized egg into the uterine wall. This interference can lead to difficulty conceiving, an increased risk of miscarriage, or other adverse pregnancy outcomes.
Identifying the Cause and Risk Factors
While the exact trigger for uterine fibroid development is not fully understood, their growth is influenced by reproductive hormones, particularly estrogen and progesterone. These hormones, which regulate the menstrual cycle, stimulate the proliferation of fibroid tissue. Fibroids tend to grow quickly during the childbearing years when hormone levels are high and typically shrink after menopause when hormone production declines.
Genetic predisposition is a strong factor; having a close family member with fibroids increases an individual’s risk. Fibroids are most common in people in their 30s and 40s. A higher incidence and earlier onset are also observed in certain ethnic groups, notably among African American women.
Management and Treatment
Management of submucosal fibroids centers on alleviating severe symptoms of bleeding and pain, often beginning with medical options. For individuals with anemia due to heavy bleeding, iron supplementation is prescribed to restore red blood cell levels. Non-hormonal medications, such as tranexamic acid, can reduce menstrual flow, though this does not address the underlying fibroid itself.
Hormonal therapies, including gonadotropin-releasing hormone (GnRH) agonists, temporarily block estrogen and progesterone production, which can shrink fibroids significantly. These medications can decrease fibroid size before planned surgery or manage symptoms short-term. However, symptoms often return once the medication is stopped.
Because of the fibroid’s location within the uterine cavity, surgical removal is often the most definitive and effective treatment for submucosal fibroids. Hysteroscopic myomectomy is the preferred, minimally invasive procedure for these growths, especially Type 0 and Type 1 fibroids. This technique involves inserting a slender instrument through the cervix and vagina to remove the fibroid directly from the uterine cavity without requiring abdominal incisions.
For individuals who are not surgical candidates or who have larger, more complex fibroids, other options exist, such as Uterine Artery Embolization (UAE). This procedure involves injecting tiny particles into the arteries supplying the fibroid, causing it to shrink by cutting off its blood supply. Traditional abdominal myomectomy or a hysterectomy (complete removal of the uterus) are generally reserved as a final option for very large fibroids or for patients who have completed childbearing and wish to ensure symptoms do not return.