Intramural Fibroids – What are they? Symptoms, Causes, Diagnosis and Treatment

Fibroids are abnormal, often benign (non-cancerous) growths that develop inside or on the outside of a woman’s uterus. While they are small, many women may not even have any symptoms but as they grow, they can cause severe abdominal pain, heavy to very heavy periods and can also be a cause of infertility. Fibroids are also knows as leiomyomas or myomas or uterine myomas or fibromas.

Intramural fibroids are the most common type of fibroids that grow in the muscular wall of the uterus. As they grow in size, the size of the uterus also grows with it.

Symptoms of intramural fibroids

As said, when the fibroids are small, the person may not see any symptoms. The symptoms differ with the location of fibroids, size and the number of fibroids that have grown. Symptoms of intramural fibroids include:

1. Menstrual changes – often leading to heavy to very heavy bleeding
2. Spotting between periods
3. Severe pain in the abdomen associated with severe abdominal cramps
4. Frequent urination
5. Pain during sex
6. Feeling of fullness or bloating in the abdomen
7. Enlargement of the abdomen
8. Very severe menstrual bleeding can lead to anaemia (less common but can happen).

Causes

The exact cause why fibroids grow is not known but the medical experts believe that higher levels of estrogen during reproductive periods can cause fibroids. This actually contradicts with the fact that fibroids are more seen in women between 40 and 50 years of age while women under 20 years are at very low risk of developing fibroids.

Certain risk factors for (intramural) fibroids include:

1. Race – Black people are at higher risk of developing recurring fibroids. It is noticed that the fibroids grow faster in their body compared to people of other races.
2. Obesity – Though this is not an established fact, a general observation by medical professionals is that fibroids are seen more in obese people.
3. Family history – If any of your mother, sister or grandmother has fibroids, you are at increased risk of developing fibroids
4. Pregnancy history – Chances of appearance/growth of fibroids go up in women who were never pregnant.

“In order to keep a tab on your uterine and overall reproductive health, it is better to go to your preferred gynecologist for regular check up” says Dr. Deepa Ganesh, one of the finest gynecologists in Chennai.

Diagnosis of intramural fibroids

Diagnosing fibroids may start with a physical examination followed by below tests:

1. Ultrasound Examination – Utrasound is an imaging test that takes a picture of the internal organs of the body using ultrasound waves. Ultrasound examination can be done using an external device that is placed on the abdomen or by using an Ultrasound probe inserted through the vagina.
2. MRI – Magnetic Resonance Imaging. A better imaging technique that can give clearer picture of the internal organs of the body.
3. CT Scan – Computed Tomography Scan. The test uses X rays to look and generate a picture of the internal organs.
4. Hysterosalpingogram (HSG) – A dye or water is injected into the uterus and then imaging is performed to get pictures of the uterus and fibroid growths.
5. Hysteroscopy – This procedure involves inserting a probe into the uterus through the vagina. The probe consists of a light and camera at the end which can transmit the internal images onto the screen.

Treatment of intramural fibroids

Treatment of fibroids depends on the type of fibroids, size of the fibroids, age of the patient, whether she intends to give birth in future etc.

Treatment using medicines:

1. Pain management medicines and iron supplements will be prescribed when the fibroids are small and if your gynecologist thinks that you are losing blood.
2. Hormone Therapy – Used to balance hormones in the body there by controlling the bleeding and growth of fibroids
3. Progestin releasing IUD – This helps in reducing the bleeding during menstruation.
4. Ganadotropin-releasing hormone (GnRH) agonists – They help in shrinking fibroids.

When medications don’t help in stopping the fibroids from growing, surgery will be the next option. Popular surgical method is Laparoscopic Myomectomy wherein the fibroids are removed using a laparoscope.

Another surgical option is the remove the uterus. This is an ultimate procedure and is last preferred choice by the gynaecologists. Once the uterus is removed, there is no way of getting pregnant and this is not a reversible procedure.

Minimally invasive procedures such as Radiofrequency ablation of fibroids, uterine artery embolization or other energy based techniques are also employed to shrink and remove the fibroids.