Exophytic fibroids are one of the types of uterine fibroids. As its name says, exophytic myomas are those that protrude from the uterus surface. If an exophytic fibroids grow outside the uterus, it’s called a subserosal fibroid. If it grows inside the uterine cavity, it’s a submucosal one. Today we are explaning how exopytic myomas differ from pedunculated ones and what treatments work for them.
What Are Uterine Fibroids?
Uterine fibroids, myomas, or leiomyomas are common non-cancerous tumors that grow in and around the uterus. Leiomyomas are categorized by their locations, and they can grow either within the muscular wall of the uterus or attached to a stalk or stem that extends from the surface of the uterus (pedunculated uterine fibroids).
What Causes Uterine Fibroids?
The root cause of fibroid tumors is still unknown but research has provided some information about fibroids so we have an understanding of factors that influence their development and growth. Some of these factors include:
- Estrogen levels;
- Race;
- Obesity;
- Vitamin D deficiency;
- Early-onset of menses, i.e. before age of 10;
- Lifestyle.
Symptoms of Fibroids
Many women with myomas experience no symptoms at all while others suffer from symptoms such as heavy bleeding, long periods, bleeding in between periods, pelvic pain and pressure, bloating, frequent urination, pain during sex, back, and leg pain, constipation, infertility, exhaustion, etc.
Women do not often know that these symptoms are not normal and should not be happening. If you are having these symptoms on an ongoing basis and they interfere with the quality of life, please consult your OB/GYN and get screened for fibroids. Eliminating uterine fibroids will get rid of these painful and annoying symptoms.
What Are the Different Types of Fibroids?
Intramural myomas embed themselves and grow within the muscular uterine walls and are the most common type of fibroid that women experience. They can grow large, can cause the uterus to stretch, and can cause fertility issues.
Subserosal and submucosal fibroids are both types of exophytic fibroids meaning they can stick out from the outer or inner surface of the uterus. Intramural fibroids, on the other hand, stay contained within the wall of the uterus.
Many people ask, “What is the difference between an exophytic fibroid and a pedunculated fibroid?” The difference is in the way they are attached to the uterus.
Exophytic fibroids are directly attached to the uterus and can be at least partially embedded in the uterine wall, while pedunculated fibroids are attached to the uterus by a small stem-like structure with the myoma masses growing at the end of it.
Subserosal myomas grow outside the uterus and can protrude from the outside wall into the surrounding pelvis, sometimes compressing the adjacent bladder, colon, small intestines, and pelvic blood vessels and nerves. Subserosal fibroids can be exophytic or pedunculated.
Submucosal myomas originate within the inner surface of the uterine wall and then grow out into the uterine cavity. They can be exophytic or pedunculated. Submucosal fibroids are usually associated with heavy bleeding during and between periods.
When an Exophytic Fibroid Goes Rogue
In rare instances, a pedunculated fibroid can grow on a long stem that allows the myoma to extend further away from its origin point than normal. This wandering or migrating fibroid, as they are called in this case, can then attach to nearby structures such as the uterus’s broad ligament.
When this happens, the fibroid tumor can tap into that structure’s blood supply and obtain nourishment from there – fibroids need a blood supply to keep living and growing. Then these rogue fibroids can drop their original attachment to the uterus and become totally dependent on the new blood supply source. They are now referred to as “parasitic leiomyomas”.
These parasitic myomas are now separated from the uterus and when spotted during imaging scans can be mistaken for an adnexal mass such as an ovarian cyst, or another type of tumor. There is a very rare possibility of fibroid torsion (the stalk twists up) causing acute abdominal pain requiring immediate medical intervention.
What Are the Most Common Treatments for Uterine Fibroids?
There are several treatments available to eliminate the symptoms of uterine fibroids including:
Hysterectomy is performed by a gynecologic surgeon and is the surgical removal of a portion of the uterus or the entire uterus. A hysterectomy may include other reproductive organs such as the cervix, ovaries, and fallopian tubes. A hysterectomy can be performed through open abdominal surgery, vaginally, laparoscopically, or robotically.
Myomectomy is a surgical procedure performed by a gynecologic surgeon where uterine fibroids are cut out of the uterus one at a time. In most cases, the leiomyomas are accessed using a laparoscope and the surgeon works through one of a few different incisions made in your lower abdomen. There are cases where the surgeon is not able to eliminate all the fibroids and any that remain will continue to grow and often require additional surgery.
Also, depending on the number and location of the fibroids removed, the uterus may be weakened in the removal areas, and should the patient become pregnant, a C-section would be required. A myomectomy can also cause scarring that may reduce the chances of conceiving or carrying a pregnancy to term.
This is a potentially complex surgery that may be difficult and result in a significant amount of internal bleeding. In the event that the bleeding cannot be well-controlled, the surgeon may need to perform a hysterectomy to keep the patient from having life-threatening bleeding.
Uterine fibroid embolization (UFE) is a non-surgical, 45-minute procedure performed by an interventional radiologist. This minimally invasive procedure is 90% effective in relieving all fibroid symptoms and works by cutting off the blood being supplied to the leiomyomas that are allowing them to live and grow. Cutting off this blood supply will cause them to shrink and die, and they will no longer create significant symptoms.
Uterine fibroid embolization is an outpatient procedure and does not require any time in the hospital. The recovery time for UFE is much shorter than with surgery and most patients can return to their normal activities 5-7 days after their procedure. Many patients have experienced full-term pregnancies after UFE.
What Is the Best Treatment for a Parasitic Leiomyoma?
Depending on the patient and the specific circumstances, the best course of action may be a myomectomy for that particular fibroid. Uterine fibroid embolization will address all of the fibroids that are attached to the uterus. In cases of an exophytic fibroid that has gone rogue and has become a parasitic fibroid, it is no longer directly attached to the uterus so it will not be influenced by the UFE treatment.
In cases where a patient has multiple myomas in addition to the parasitic leiomyoma, a combination of UFE followed by a myomectomy would be the least invasive method of addressing all the benign uterine tumors while preserving the integrity of the uterus.
If you are experiencing fibroid-related symptoms or are interested in learning more about how uterine fibroid embolization may help you, please contact the Atlanta Fibroid Center. Dr. John Lipman and Dr. Ermentrout have over 35 years of experience combined in treating fibroids with UFE. They have helped thousands of women regain their quality of life. Do not settle for suffering in silence. With a quick 45-minute procedure and a week of recovery, you can be done with painful fibroid symptoms forever.
