Intramural Fibroids

Intramural fibroids are identified as those that grow mainly within the uterus masculine wall. They do infer fertility and cause heavy menstrual bleeding. Today we are going to focus on uterine fibroids of intramural location, their symptoms, methods to diagnose them, and treatment options.

Types of Intramural Fibroids

Uterine fibroids also called uterine myomas are non-cancerous tumors that are found in the uterus or cervix. There are different types of fibroids classified by where they are located and/or how they grow.

Types of uterine fibroids: submucosal, subserosal, intramural, and cervical
Types of uterine fibroids: submucosal, subserosal, intramural, and cervical

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 that of 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 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 (e.g. left anterior, right fundal, etc.) side of the uterus.

Intramural fibroids
Intramural fibroids

Symptoms Caused by Intramural Fibroids

Many women may not realize they have fibroids if they don’t have any symptoms, while others suffer a variety of uncomfortable, and sometimes very debilitating, side effects.

Fibroids of intramural location can cause mild or severely painful symptoms. One of the most common is 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 (e.g. palpitations, chest pain).

Some women experience lower back pain and pelvic pain. Larger anterior fibroids can exert pressure on the bladder to cause frequent urination or waking multiples each night to urinate. Posterior intramural fibroids can press on adjacent bowel loops causing constipation. Large or numerous amounts of fibroids can cause the abdomen to protrude, particularly anterior ones.

Large intramural myomas can also affect fertility and the ability of a woman, who does become pregnant, to carry the baby to term.

Read our in-depth article on Fertility and Infertility with Fibroids.

Intramural Fibroids And Pregnancy

Many women, who are trying to become pregnant, have issues conceiving. One reason may be the presence of fibroids. Intramural and submucosal are two types of fibroids that can interfere with a woman’s ability to conceive.

Intramural fibroids may affect the sperm’s ability to fertilize the egg preventing conception or may inhibit the implantation into the uterine wall.

The closer and more effect on the uterine cavity a fibroid has, the more likely it can 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.

Diagnosing Intramural Fibroids

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

Intramural Fibroid Treatment

There are different treatments available to help relieve symptoms of intramural fibroids. Some treatments require invasive surgery with lengthy recovery times, 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 – Surgical procedure that removes the tumors while leaving the uterus intact. Requires a hospital stay and recovery time of 4 – 8 weeks. Risks include damage to nearby organs or the uterus, excessive bleeding requiring a blood transfusion, infertility issues, may weaken the uterus so full-term pregnancy may not be possible, if pregnancy does occur it would require a c-section to deliver, new tumors often grow and therefore it has a high recurrence rate (11%/year).

Hysterectomy is a surgical procedure that removes the entire uterus (or all but the cervix). Requires 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).

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), are typically limited to 6-month use due to significant bone loss it causes. Fibroids return to their original size after ceasing the medication.

Uterine Fibroid Embolization (UFE) – a non-surgical minimally invasive procedure that is 90% effective in relieving fibroid symptoms. The procedure stops the blood flow to the fibroids and causes them to shrink and/or die off. UFE does not require a hospital stay, yields permanent results, and patients are discharged the same day as the procedure with just a bandaid. The recovery time is 5-7 days.

If you have been diagnosed with fibroids and are experiencing symptoms, please call Atlanta Fibroid Center at (770) 953-2600 or make an appointment online for a consultation. We would welcome the opportunity to bring you relief from your fibroid symptoms.

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