Heavy periods or difficulty getting pregnant? Uterine fibroids could be the reason

Uterine fibroids are some of the most common benign (non-cancerous) tumors in women of reproductive age. They arise from the muscular wall of the uterus and can vary in size, number and location.

There are various kinds of fibroids, but the most important ones to take note of are the submucosal fibroids. They grow just under the uterine lining and can significantly affect menstrual health and fertility.

What are submucosal fibroids?

Submucosal fibroids develop from the muscle layer of the uterus (myometrium) and grow just beneath the inner layer of the uterus (endometrium). They are more likely to cause symptoms because as they grow larger, they bulge into the uterine cavity.

Depending on the degree of growth into the uterine muscle, submucosal fibroids are divided into three types. Type 0 is a pedunculated submucosal fibroid that is completely intracavitary, attached by a stalk. Type 1 has less than 50 per cent of the fibroid in the uterine muscle and most of it is protruding into the cavity of the uterus. Type 2 fibroids have more than 50 per cent of the fibroid in the muscle of the uterus, so they are more embedded and generally more difficult to remove.

What are the symptoms?

Some women with submucosal fibroids have no symptoms. But these fibroids often cause abnormal uterine bleeding and can distort the uterine cavity. Women may have heavy bleeding during their periods, bleeding that lasts a long time, bleeding that occurs irregularly between periods, and spotting before and after the period. Some may also have chronic pelvic pain or low back pain.

Anaemia due to excessive menstrual blood loss can cause fatigue, weakness and dizziness, as well as lower energy levels. Submucosal fibroids can also block the implantation of a fertilized embryo, making conception more difficult for some women and potentially contributing to infertility.

What causes submucosal fibroids?

The exact cause of fibroid formation is still unclear. However, several factors are believed to contribute to their growth. The female hormones oestrogen and progesterone are known to stimulate fibroids. That is why they often grow during the reproductive years and tend to shrink after menopause when hormone levels decline.

Research has also suggested that some genetic changes may play a role in the development of fibroids and that they can sometimes be inherited. Obesity could be a risk factor, as more body fat results in higher circulating estrogen levels. Low intake of fruit and vegetables and vitamin D deficiency have also been associated with a higher risk of fibroid development.

How are submucosal fibroids diagnosed?

Your doctor may order one or more investigations depending on your symptoms and findings on examination. Ultrasound (pelvic ultrasonography) is the first imaging test usually used to diagnose fibroids. Saline Infusion Sonography (SIS) is a special ultrasound in which sterile saline is injected into the uterus to improve the visibility of the uterine cavity and to detect submucosal fibroids.

You may be advised to have an MRI of the pelvis, as this gives a more detailed picture, especially if the fibroids are larger or more complex. A diagnostic hysteroscopy can be done as well. A thin camera is passed through the vagina and cervix into the uterus to directly look into the uterine cavity and confirm the diagnosis .

How are submucosal fibroids treated?

The treatment depends on a number of factors including the patient's age, the severity of symptoms, the size and type of fibroid and whether the patient wants to preserve fertility.

Hysteroscopic myomectomy is the treatment of choice for many women especially with type 0 and type 1 submucosal fibroids. The procedure is minimally invasive where a small camera is put through the vagina and cervix into the uterus to see and remove the fibroid with no cuts on the outside of the body.

For larger or deeply embedded Type 2 submucosal fibroids, a combined hysteroscopic and laparoscopic approach may be advised. Laparoscopy involves insufflating the abdominal cavity with gas and inserting a camera through tiny incisions in the abdomen. This allows the surgeon to safely watch the procedure from outside the uterus while taking out the fibroid from inside.

Hysterectomy (surgical removal of the uterus) may be considered as definitive treatment in women who have completed childbearing, who have severe symptoms, multiple fibroids and who do not wish to retain the uterus.

When should you see a doctor?

Never ignore heavy or prolonged menstrual bleeding. If you experience persistent abnormal uterine bleeding, pelvic pain, symptoms of anaemia or difficulty conceiving, it is important to consult a gynaecologist. Early diagnosis and appropriate treatment can relieve symptoms, improve quality of life and help preserve fertility where desired.

(The author is a senior consultant, obstetrics & gynaecology, Manipal Hospital, Old Airport Road, Bengaluru)

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.