Intramural Fibroids

Intramural fibroids are one of three types of uterine fibroids that can be found growing in or on the uterus. They can cause painful symptoms and heavy bleeding and can also affect fertility. Today we will be sharing information about intramural fibroids, how they are diagnosed, associated symptoms, and treatment options.

What Are Intramural Fibroids?

Uterine fibroids also called known as leiomyomas or myomas, are non-cancerous tumors that grow in, on, or within the uterus. Sometimes, fibroids can even grow from inside the uterus and push through the uterine wall to the outside of the uterus – transmural fibroids.

Intramural fibroids are the most common and grow in the muscle tissue of the uterus. They can range in size from a small pearl to a grapefruit. The cause of intramural myomas is not fully known but it is thought they may be caused by abnormal muscle cells that are influenced by estrogen.

Intramural vs Intermural Fibroids

The term “intermural fibroids” is often mistakenly used when individuals actually mean “intramural fibroids.” This confusion arises due to the subtle but significant difference between the prefixes “inter-” and “intra-,” which have distinct meanings.

The prefix “intra-” means “within” or “inside,” indicating that something is happening or located inside the boundaries of a specific entity, system, or organization. In the context of fibroids, “intramural fibroids” refer to non-cancerous growths that develop within the muscular wall of the uterus.

On the other hand, the prefix “inter-” means “between” or “among,” signifying that something is happening or taking place between two or more separate entities, systems, or organizations. “Intermural fibroids” is not the correct term to use because it would suggest that the fibroids are occurring between the walls of more than one uterus which obviously is not the case.

Types of Intramural Fibroids

Intramural uterine fibroids are separated into three categories:

  • Fundal intramural fibroids grow in the upper part of the uterus;
  • Anterior intramural fibroids grow in the front of the uterus;
  • Posterior intramural fibroids grow in the back of the uterus.

Any of these fibroids can be located on the left or right side of the uterus, e.g. left anterior, right fundal, etc.

Intramural fibroids
Intramural myomas

Symptoms Caused by Intramural Myomas

Many women may not realize they have fibroids because they do not experience any associated symptoms, while others suffer a variety of uncomfortable, and sometimes debilitating side effects.

  • Heavy menstrual periods that last an abnormally long amount of time or bleeding in between periods.
    • Losing excess blood can result in anemia which can cause fatigue, migraine-like headaches, and even increase the risk for heart issues – palpitations, and chest pain.
  • Lower back pain and pelvic pain.
  • Frequent urination or waking multiple each night to urinate can be caused by large anterior intramural fibroids exerting pressure on the bladder.
  • Constipation can be caused by posterior intramural leiomyomas pressing on the nearby bowel loops.
  • A protruding abdomen can be the result of large or numerous amounts of fibroids causing the abdomen to protrude similar to that of pregnancy (particularly anterior fibroids).
  • Fibroids can also cause pain during sex, pelvic pressure, or bloating.
  • Large intramural myomas can also affect fertility and the ability of a woman, who does become pregnant, to carry the baby to term.

Intramural Fibroids And Pregnancy

Many women, who are trying to become pregnant, have issues conceiving. Both intramural and submucosal fibroids have been identified as types of fibroids that can interfere with a woman’s fertility and affect her ability to conceive.

Intramural fibroids can cause blockages that may affect the sperm’s ability to fertilize the egg and prevent conception or may inhibit the embryo’s implantation into the uterine wall.

Intramural fibroids that are large or numerous, can compromise the uterine cavity and affect fertility. Fibroids that are 6 cm or larger can cause complications for a pregnant woman as it is taking up space the embryo needs to grow. The elimination of intramural leiomyomas can lead to a successful pregnancy.

Diagnosing Intramural Fibroids of the Uterus

Some fibroids can be detected during an OB-GYN appointment through a physical exam or ultrasound. Ultrasound images do not provide a high-quality resolution image, so some fibroids are hard to detect due to their location, small size, or surrounding bowel loops which interfere with the transmission of the sound waves.

Intramural masses can be best diagnosed through an MRI which has a much higher resolution and can also produce images in all three planes (3D images) which allow for the most accurate viewing of potential fibroids.

Intramural Uterine Fibroid Treatments

There are different treatments available to help relieve symptoms of intramural fibroids. Some treatments require invasive surgery with lengthy recovery times, while others are hormone-based therapies and can cause early menopause or osteoporosis. Uterine fibroid embolization is a non-surgical, minimally invasive procedure that preserves the uterus. The following is an overview of the different options.

Myomectomy is a surgical procedure where the surgeon cuts the fibroid tumors out of the uterus one at a time but does not remove the uterus. A myomectomy requires a hospital stay and a recovery time of 4-8 weeks.

Risks include damage to nearby organs or the uterus, excessive bleeding requiring a blood transfusion, infertility issues, weakens the uterus so full-term pregnancy may not be possible. If a woman does become pregnant after a myomectomy they often require a mandatory c-section to deliver.

Sometimes surgeons are not able to reach all of the fibroids to remove them, and new tumors often grow, and therefore it has a high recurrence rate of 11% a year.

Hysterectomy is a surgical procedure that removes the entire uterus. It can also include the cervix, one or both ovaries, and fallopian tubes. A hysterectomy requires a hospital stay and a recovery time of 6-8 weeks. Risks include damage to other nearby organs (e.g. the bladder, urethra), blood vessels, and closely associated nerves, blood loss, blood clots, and removal of the ability to conceive. Increased risk of sexual dysfunction (e.g. loss of libido, loss of orgasm), urinary leaking, bone loss leading to osteoporosis, and increased cardiovascular risk, e.g. high blood pressure, heart attack, stroke.

Hormone therapy – gonadotropin-releasing hormone (GnRH) agonists or antagonists hormone treatments initiate menopause by lowering the body’s estrogen level to temporarily shrink fibroids. These drugs are expensive, have significant side effects (e.g. significant hot flashes), and are typically limited to 6-month use due to the significant bone loss it causes. Fibroids return to their original size after ceasing the medication.

Uterine Fibroid Embolization (UFE) is a non-surgical minimally-invasive procedure that blocks the blood flow to all fibroids that are attached to the uterus – no matter their size or where they are located – unlike a myomectomy. This causes all subserosal, submucosal, and intramural leiomyomas of the uterus to shrink or die off.

The procedure normally only takes about 45 minutes, does not require a hospital stay, and patients are discharged the same day to recover comfortably at home with just one small bandaid.

UFE is 90% effective in relieving fibroid-related symptoms and yields permanent results without compromising the patient’s uterus. Many women have conceived and given birth to full-term babies after UFE.

If you have been diagnosed with fibroids and are experiencing symptoms, please call the Atlanta Fibroid Center® at (770) 953-2600 or make an appointment online for a consultation.

Dr. John Lipman has over 25 years of experience performing UFE and has helped over 10,000 women break free from fibroids. We would love to help you be free from fibroids too! Contact us today!

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