Subserosal fibroids grow outside the uterus underneath the serosa. They might be responsible for bulk-related symptoms such as pelvic pain, bloating, back pain, sciatica, increased urinary frequency, and constipation. Today we are bringing you through the mechanism of subserosal fibroids affecting women, diagnosing methods, and treatment options.
Uterine fibroids are non-cancerous tumors also called myomas or leiomyomas that are found in the uterus or cervix. The cause of fibroids is still relatively unknown, but there have been studies that highlighted patterns related to increased fibroid incidence. The patterns observed included:
- Fibroids most frequently occur in women between the ages of 30 and 40.
- Women who start their menstrual cycles at younger ages are more likely to develop fibroids.
- Family history can increase your chance of developing fibroids.
- Black women have a higher incidence of fibroids, they develop fibroids at younger ages and their fibroids grow more rapidly. As a result, they are much more likely to undergo a hysterectomy.
- Obesity and high blood pressure can play a part in fibroid growth.
Symptoms Caused by Subserosal Fibroids
Subserosal myomas develop at the outer edge of the uterus underneath the outer covering called the serosa. They can range in size from a small pearl to that of a melon. They can be embedded in the muscle of the uterus or attached to the outside of the uterus or via a peduncle – a narrow stalk or stem.
Many women may not realize they have fibroids and may not ever experience symptoms, while others endure a myriad of symptoms that significantly affect their quality of life.
Since subserosal fibroids grow away from the uterus (i.e. they don’t affect the lining or the uterine cavity), they do not often cause the heavy bleeding associated with the submucosal and large intramural fibroids. As they grow, subserosal leiomyomas cause bulk-related symptoms by pressing on whatever organ or structure is next to them.
Subserous fibroid symptoms can include:
- Pelvic pain;
- Feeling “heavy” or “full”;
- Abdominal cramping;
- Back or leg pain (sciatica);
- Increased urinary frequency (nocturia);
- Urinary incontinence;
- Painful sex (dyspareunia).
Anterior subserosal fibroids in the front of the uterus cause increased urinary frequency and waking at night to pee.
Posterior subserosal fibroids located in the back of the uterus press on the large bowel and result in constipation. They can also cause the same sciatica pain seen when someone injures their lower back. This can mislead some providers into evaluating the spine when the culprit is the large subserosal fibroid(s).
Video: Fibroid Pain Due to Subserosal Fibroids
Subserosal 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. Subserosal uterine fibroids are not known to cause infertility. In rare cases, due to the location of a subserosal fibroid, a blockage of the fallopian tube or cervix may occur making it difficult for the sperm or fertilized egg to reach its destination.
Diagnosing Subserosal Fibroids
Some fibroids can be detected during an OB-GYN appointment through a physical exam. Subserosal fibroid ultrasound may be then recommended by your gynecologist, however, ultrasound images do not provide a high-quality resolution image so some fibroids are hard to detect due to their location or size.
Subserous myomas can be best diagnosed through an MRI, which has the highest resolution of any of the radiology imaging studies available. It can image in multiple planes giving the radiologist a 3-dimensional representation of the uterus and any of the fibroids.
Subserosal Fibroid Treatment
There are some different treatments available to help relieve symptoms of subserous leiomyomas. Some treatments require invasive surgery with lengthy recovery times, others are hormone-based therapies and can cause early menopause or osteoporosis. UFE is a non-surgical, minimally invasive procedure that preserves the uterus.
The following is an overview of the different subserosal fibroid treatment options:
1. Myomectomy is a surgical procedure that removes some of the fibroid tumors while leaving a number of the fibroids behind along with the uterus. Requires a hospital stay and recovery time of 4-8 weeks depending on whether it is open or laparoscopic surgery. 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 will require a C-section to deliver.
Patients also must sign a waiver saying they understand that while they signed up for myomectomy, they may wake up with a hysterectomy. However, the biggest weakness of myomectomy is the fact that typically there as many fibroids left behind in the uterus as were removed. These fibroids tend to be the smaller ones, but they will grow immediately, and most women that undergo myomectomy will need a second procedure within 5 years with 11% recurrence rate per year!
2. Hysterectomy is a surgical procedure that removes the entire uterus. Requires hospital stay and a recovery time of 6 – 8 weeks. Risks include damage to other nearby organs such as the bladder, urethra, blood vessels, and closely associated nerves, blood loss, blood clots, and elimination of the ability to conceive. There are also significant after-effects of losing your uterus: sexual dysfunction, i.e. loss of libido, loss of orgasm, urinary leaking, bone loss to name a few.
3. Gonadotropin-releasing hormone (GnRH) agonists or antagonists hormone treatments create the onset of menopause by lowering the body’s estrogen level to eliminate or shrink fibroids. These drugs are expensive and are not recommended as a long-term solution as they can cause osteoporosis. They are typically used to boost up a woman’s iron and hemoglobin levels into a range where it is safe to perform surgery. Fibroids return to their full, pre-treatment size once the medication is discontinued.
4. Uterine Fibroid Embolization (UFE) – a non-surgical, outpatient, minimally invasive procedure that is 90% effective in relieving fibroid symptoms. The procedure stops the blood flow to all of the fibroids and causes them to shrink and/or die off. UFE does not require a hospital stay, yields permanent results, and recovery time is typically less than one week. It has the longest track record of safety and efficacy of any of the non-surgical treatment options for fibroids (over 25 years) and was approved by the American College of Obstetricians & Gynecologists back in 2008. It is covered by all insurance carriers unlike some of the newer procedures and allows women to have children afterward.
If you have been living with the unpleasant symptoms of subserosal fibroids and desire relief, please call the Atlanta Fibroid Center at (770) 953-2600 to make an appointment for a UFE consultation with one of the nation’s leading UFE experts Dr. John C. Lipman, or make an appointment online at ATLii.com.