Submucous fibroids, a type of uterine fibroids, are benign tumours that form within the uterine lining (endometrium). Unlike other fibroid types, such as intramural and subserosal, which develop within the muscle layer of the uterus or on its outer surface respectively, submucous fibroids grow just beneath the interior surface of the uterus. This positioning can significantly influence their symptoms and impact on fertility and menstrual cycles.
The development of submucous fibroids is not fully understood, but a combination of genetic, hormonal, and environmental factors is thought to play a role. They are particularly noted for their association with heavy menstrual bleeding, prolonged periods, and sometimes, an increased sensation of pressure in the lower abdomen. Unlike their counterparts, submucous fibroids have a more direct effect on the uterine cavity, which can lead to complications with menstruation and infertility.
Our clinic, situated in the heart of Central London, specialises in the diagnosis and treatment of fibroids including submucosal subtypes. With a focus on providing comprehensive care, we utilise advanced gynaecology scanning techniques, which are pivotal for accurate diagnosis and effective treatment planning. Our unique position in Central London, combined with advanced diagnostic capabilities and a personalised approach to care, ensures that every patient receives the highest standard of treatment for submucous fibroids.
If you are interested in this article you may also wish to read our article Myomectomy vs Hysterectomy for Fibroids
What are submucosal fibroids, and how do they differ from other types of fibroids?
Submucous fibroids represent a specific subset of fibroids that grow beneath the endometrium, the inner lining of the uterus. This location is important to understanding both their symptoms and the specific challenges they present. Unlike intramural fibroids, which develop within the uterine wall, or subserosal fibroids, which grow on the uterus's outer surface, submucous fibroids protrude into the uterine cavity. This can lead to a range of symptoms that significantly affect a woman's quality of life and reproductive health.
One of the primary distinguishing features of submucous fibroids is their impact on menstrual bleeding and fertility. Women with submucous fibroids often experience heavier and more prolonged menstrual periods. This is due to the fibroids' location within the uterine cavity, which can interfere with the normal shedding and regeneration of the endometrial lining. In addition, submucous fibroids can distort the uterine cavity, creating challenges for embryo implantation and increasing the risk of miscarriage, making them of particular concern for women trying to conceive.
The growth patterns of submucous fibroids also set them apart. They can grow as pedunculated fibroids, attached to the endometrium by a slender stalk, or as sessile fibroids, with a broader base directly on the uterine wall. These growth patterns can influence both symptomatology and treatment options, emphasising the need for a thorough diagnostic process.
Understanding the nuances between submucous and other fibroid types is critical for effective treatment. At our clinic, we leverage advanced scanning techniques to accurately diagnose submucous fibroids, enabling tailored treatment plans that address the unique challenges they present. Our approach ensures that women receive the most effective interventions, aimed at alleviating symptoms and preserving fertility when desired.
What symptoms are associated with submucous fibroids?
Submucous fibroids can cause a range of symptoms that may significantly affect a woman's health and quality of life. The most common symptoms associated with submucous fibroids include the following:
Heavy menstrual bleeding
One of the hallmark symptoms of submucous fibroids is an increase in the volume and duration of menstrual bleeding. This can lead to menorrhagia, a condition where menstrual bleeding is heavy enough to disrupt a woman’s normal activities, and may well lead to anaemia.
Irregular menstruation
Women with submucous fibroids may experience changes in their menstrual cycle, including irregular periods that are unpredictable in timing and intensity.
Pelvic pain and pressure
As submucous fibroids grow, they can exert pressure on the walls of the uterus and other pelvic organs, leading to a sensation of fullness, discomfort, or pain in the pelvic region.
Fertility challenges
The presence of fibroids within the uterine cavity can interfere with the implantation of the embryo, potentially leading to difficulties in conceiving or an increased risk of miscarriage.
Frequent urination or constipation
Larger fibroids can press against the bladder or rectum, leading to urinary symptoms or constipation.
When should I seek medical advice?
Recognising when to seek medical advice for submucous fibroids is key to managing your health proactively. Given their potential impact on menstrual bleeding, fertility, and overall well-being, it’s important not to overlook symptoms that may indicate the presence of fibroids. Here are several scenarios when consulting a healthcare professional becomes important
Heavy or prolonged periods
If you’re experiencing unusually heavy or prolonged periods that disrupt your daily activities, it’s advisable to seek medical attention. Heavy bleeding can lead to iron deficiency anaemia, a condition that may cause fatigue and weakness. Persistent or severe pain in the pelvic area, especially if it coincides with your menstrual cycle, warrants a professional evaluation to rule out fibroids or other underlying conditions.
Changes to your menstrual cycle
Any significant changes in your menstrual cycle, such as irregular periods, spotting between cycles, or unusually painful periods, should prompt a visit to your gynaecologist. If you're having trouble becoming pregnant or have experienced multiple miscarriages, submucous fibroids could be a contributing factor. A thorough evaluation can help determine the best course of action to support fertility. These symptoms may suggest that a fibroid is pressing against your bladder, affecting its function.
How are submucous fibroids diagnosed, and what advanced scanning techniques are used?
The diagnosis of submucous fibroids is important for developing an effective treatment plan. Early and accurate diagnosis can help manage symptoms more effectively and prevent potential complications related to fertility and menstrual health. The diagnostic process typically begins with a comprehensive medical history and physical examination, followed by advanced imaging techniques that provide detailed insights into the size, location, and impact of the fibroids. Here’s an overview of the diagnostic process and the advanced scanning techniques utilised
Ultrasound scanning
The first line of investigation for suspected fibroids is usually an ultrasound scan. This non-invasive technique uses sound waves to create images of the uterus, helping identify the presence and location of fibroids. For submucous fibroids, a transvaginal ultrasound, where the ultrasound probe is inserted into the vagina, offers a closer and more detailed view of the uterine lining.
Saline Infusion Sonography (SIS)
SIS enhances the imaging of the uterine cavity. By introducing saline into the uterus via a thin catheter, this ultrasound-based technique can provide a clearer picture of submucous fibroids and help distinguish them from other types of uterine abnormalities.
Magnetic resonance imaging (MRI)
MRI is employed when a more detailed imaging of fibroids is necessary. This technique is particularly useful in mapping and measuring fibroids before surgical procedures or when considering uterine-sparing treatment options. MRI offers the advantage of high-resolution images, enabling precise localisation of submucous fibroids and assessment of their impact on the uterine structure.
What treatment options are available for submucous fibroids?
The treatment of submucous fibroids is tailored to the individual's symptoms, fibroid size, location, and personal health goals, such as preserving fertility. Our clinic in Central London offers a comprehensive range of treatment options, from conservative management to advanced surgical interventions. The choice of treatment is influenced by the severity of symptoms, the impact on quality of life, and the patient's preferences. Here's an overview of the available treatments:
Medication
For women experiencing mild symptoms, medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can provide relief from pain and reduce menstrual bleeding. Gonadotropin-releasing hormone (GnRH) agonists may also be used temporarily to shrink fibroids and lessen symptoms, particularly before surgery.
Hysteroscopic myomectomy
Myomectomy is the surgical removal of fibroids, preserving the uterus and fertility. It can be performed through various techniques, including hysteroscopy for submucosal fibroids, where a thin, lighted instrument is inserted through the vagina and cervix into the uterus. This approach is particularly effective for fibroids that are inside the uterine cavity, offering relief from symptoms while maintaining reproductive potential.
Hysterectomy
For women with severe symptoms who do not wish to preserve their fertility, a hysterectomy, or the removal of the uterus, may be considered. This option provides a permanent solution to fibroid-related symptoms but is typically reserved for when other treatments have failed or are not suitable.
Can submucosal fibroids affect fertility, and what are the implications for women planning pregnancies?
Submucous fibroids pose a unique concern for women who are planning to conceive, given their location within the uterine cavity. These fibroids can have a direct impact on fertility and pregnancy outcomes by interfering with the implantation of the embryo, altering the shape of the uterine cavity, and affecting the uterine lining's ability to sustain a pregnancy. Understanding the implications of submucous fibroids on fertility is important for women who wish to become pregnant. Here are the key considerations:
Implantation challenges
Submucous fibroids can distort the uterine cavity, creating a less hospitable environment for an embryo to implant. This distortion can lead to difficulties in achieving pregnancy.
Increased risk of miscarriage
The presence of fibroids within the uterine lining can increase the risk of miscarriage, especially if the fibroids are large or located near the site of implantation. The fibroids may interfere with the normal development of the pregnancy, leading to a loss.
Impact on pregnancy and delivery
Even after successful conception, submucous fibroids can affect pregnancy progression and delivery. They may be associated with a higher risk of preterm labour, abnormal placenta development, breech presentation, and the need for caesarean delivery.
Given these potential challenges, it's essential for women with submucous fibroids who are planning to conceive to consult with a specialised gynaecologist. At our clinic in Central London, we offer a comprehensive fertility assessment for women with fibroids, including advanced imaging to evaluate the size and location of fibroids and their impact on the uterine cavity. Our treatment approach is tailored to preserve fertility and improve pregnancy outcomes, with options ranging from careful monitoring to minor/ out-patient surgical interventions aimed at removing fibroids while minimising impact on the uterine structure.
Our goal is to support women in achieving a successful pregnancy, providing expert care and guidance throughout the process. By addressing submucous fibroids effectively, we strive to optimise fertility and ensure the best possible outcomes for women and their families.
What follow-up care is recommended for patients with submucous fibroids?
Effective management of submucous fibroids doesn’t end with treatment; follow-up care is a critical component of ensuring long-term health and well-being. For women who have undergone treatment for submucous fibroids, whether surgical or non-surgical, regular follow-ups with their healthcare provider are essential to monitor recovery, assess the effectiveness of treatment, and detect any recurrence early. Here's what recommended follow-up care typically involves:
Post-treatment monitoring
After treatment, patients may be scheduled for periodic evaluations, which can include physical exams and imaging tests such as ultrasound scans. These appointments allow healthcare providers to monitor the healing process, evaluate the success of the treatment in reducing fibroid size and symptoms, and check for signs of new fibroid growth.
Symptom review
During follow-up visits, patients are encouraged to discuss any continuing or new symptoms with their healthcare provider. This ongoing communication helps in adjusting treatment plans if necessary and in addressing any concerns or complications that may arise post-treatment.
Lifestyle and wellness guidance
Follow-up care also offers an opportunity to discuss lifestyle modifications that can support overall health and potentially reduce the risk of fibroid recurrence. This might include dietary changes, exercise, stress management techniques, and other holistic approaches to wellness.
Fertility planning
For women who are looking to conceive after treatment for submucous fibroids, follow-up care includes fertility assessments and planning. Healthcare providers can offer guidance on optimal timing for conception and any additional fertility support that may be needed.
Understanding the importance of follow-up care is essential for patients undergoing treatment for submucous fibroids. It ensures that the benefits of treatment are sustained over time, provides reassurance, and maintains the health and quality of life for those affected.
Conclusion
Concluding our discussion on submucous fibroids, it's clear that understanding, diagnosing, and treating this condition requires a nuanced approach. From recognising the signs and symptoms to pursuing the most appropriate treatment pathway, every step is important in managing the impact of submucous fibroids on a woman's health and fertility. At our clinic, we are dedicated to offering comprehensive care that addresses not only the physical aspects of submucous fibroids but also the emotional and psychological challenges they may present.
Our commitment to providing advanced diagnostic and treatment options, coupled with personalised follow-up care, underscores our goal of establishing a clinic known for both its educational outreach and exceptional clinical care. We aim to empower our patients with the knowledge and support they need to make informed decisions about their health, ensuring they feel supported throughout their treatment journey.
Our newly established private gynaecology clinic is located in the heart of Central London. Our founder is not only fluent in Arabic but also has an NHS base at the reputable Guy's and St Thomas' Hospital, ensuring a blend of personalised care with clinical excellence.
Our clinic's unique selling points lie in our ability to offer one-stop service that includes advanced gynaecology scanning, an essential component of any gynaecological consultation. By providing this alongside a bilingual service, we aim to meet the specific needs of our patients, offering a one-stop solution for gynaecological care that addresses both the complexities of submucous fibroids and a wide range of other gynaecological issues.
Author: Mr Osama Naji
Mr Naji offers a “one-stop” gynaecology clinic for instant detection of various gynaecological cancers as well as providing all the diagnostic and treatment services needed under one roof.
Mr Naji provides advanced gynaecology scanning which is essential when conducting any gynaecology consultation, he is bilingual in English and Arabic and has an NHS base at the highly reputable Guy's and St Thomas' Hospital in London.
He is passionate about raising awareness of various subtle signs and symptoms of gynaecological conditions that are often overlooked by patients.