Uterine fibroids, or leiomyomas, are common, non-cancerous growths that develop within or on the muscular walls of the uterus. These growths vary in size, number, and location, which determines the symptoms a person may experience. While many fibroids cause no symptoms, others can impact daily life and reproductive health. Understanding the specific classification of a fibroid is necessary for appropriate management.
Understanding Uterine Fibroid Types
Fibroids are classified based on where they grow in relation to the uterine wall. The term “exophytic” describes a growth that projects outward from the surface of the uterus, distinguishing it from intramural fibroids, which remain within the uterine muscle wall. Exophytic fibroids include two main subtypes: subserosal and submucosal fibroids.
Subserosal fibroids grow just beneath the serosa, the outer lining of the uterus, and project into the pelvic cavity. Submucosal fibroids originate in the inner lining and project into the uterine cavity.
Exophytic fibroids are also described by their attachment method: sessile (broad base) or pedunculated (attached by a narrow, stalk-like structure). Pedunculated subserosal fibroids pose a risk of torsion (twisting of the stalk). Torsion cuts off the blood supply, causing acute abdominal pain that requires immediate medical attention.
Identifying Common Clinical Signs
Symptoms of an exophytic fibroid are linked to its size and location relative to nearby organs. Since these fibroids grow outward into the pelvic space, their main impact is pressure on surrounding structures. Patients may feel pelvic pressure or fullness in the lower abdomen, which increases as the fibroid grows larger.
If the fibroid presses on the bladder (anteriorly), it can lead to frequent urination or the sensation of incomplete emptying. If it presses toward the back, it can impact the bowel, causing constipation or rectal pressure. Although heavy menstrual bleeding is more commonly associated with submucosal fibroids, large exophytic fibroids can still contribute to abnormal bleeding or discomfort during intercourse.
Confirming the Diagnosis
Diagnosis typically begins with a review of symptoms and a pelvic examination. Imaging is then used to locate the growth and determine its relationship to the uterus and other pelvic structures. Pelvic ultrasound (transabdominally or transvaginally) is the preferred initial imaging modality due to its accessibility and effectiveness.
While ultrasound confirms the presence of a mass, Magnetic Resonance Imaging (MRI) is often used for a more detailed assessment. MRI provides superior soft-tissue contrast, allowing physicians to map the size, number, and location of the fibroids, which is helpful for surgical planning. If significant blood loss is reported, blood tests are conducted to check for anemia, a common complication of heavy bleeding.
Medical and Surgical Management
Management is tailored to the severity of symptoms, fibroid characteristics, and the patient’s fertility goals. For small, asymptomatic fibroids, expectant management (observation) is often recommended, as intervention is frequently unnecessary. If symptoms are mild, medical options like hormonal contraceptives or nonsteroidal anti-inflammatory drugs (NSAIDs) can manage heavy bleeding or pain.
Hormone therapies, such as Gonadotropin-releasing hormone (GnRH) agonists, temporarily shrink fibroids by reducing estrogen and progesterone levels. These medications are sometimes used preoperatively to decrease fibroid size or to manage symptoms in patients nearing menopause. Minimally invasive procedures like Uterine Fibroid Embolization (UFE) block the blood flow to the fibroids, causing them to shrink.
For definitive treatment, surgical removal via myomectomy preserves the uterus and is preferred by those who wish to maintain fertility. Exophytic fibroids, particularly the pedunculated subserosal type, are well-suited for minimally invasive laparoscopic or robotic myomectomy. This approach uses small abdominal incisions to insert specialized instruments and a camera to detach the fibroid from the outer uterine wall. This method results in a shorter hospital stay, less pain, and a faster recovery compared to traditional open abdominal surgery.