Submucosal fibroids – symptoms, risk factors and diagnosis

Fibroids are benign (non cancerous) growth of tissues inside or outside the uterus. Uterine fibroids are also called ‘leiomyomas’. Depending on the location of the unwanted growths, the fibroids are categorized into different types.

Types of fibroids:

1. Intramural fibroids
2. Submucosal Fibroids
3. Subserous and Broad Ligament & Cervical fibroids

If you are interested in learning about intramural fibroids, we already have an article for you.

Submucosal fibroids

Submucosal fibroids are those that grow inside the uterine, just under the surface of endometrial layer. Endometrial layer is the inner lining of the uterus that regularly keeps forming, thickens and falls off if the egg (released during the middle of menstrual cycle) is not fertilized by a sperm. Submucosal fibroids are the second common type of fibroids seen followed by intramural fibroids. In general, fibroids may grow independently varying in size or in clusters. In extreme cases, fibroids can grow to the size of a melon weighing few kilos.  Small fibroids may not cause any symptoms or mild symptoms that may not look like a problem but as they grow, they can cause heavy menstrual bleeding, extreme abdominal pain and even spotting between menstrual cycles.

Symptoms of Submucosal fibroids

1. Heavy menstrual bleeding or extended periods of bleeding (this happens with any type of fibroid)
2. Anemia, rare but in severe cases of menstrual bleeding, this can happen.
3. Extreme pain in abdomen and lower back
4. Tiredness or fatigue
5. The person can see large to very large blood clots during periods.

Risk factors for developing fibroids

1. Age – women may start developing fibroids from 30 years till menopause. As menopause approaches, the size of fibroids may shrink. If the menopause happens at a later age than normal, the odds of developing fibroids may go up. Also, the age when a girl first menstruates seem to directly co-relate to developing fibroids at a later age. The sooner the first period, the higher the risk of fibroids.
2. Family history – If a woman’s sister or mother has fibroids, there is a high probability for her to have fibroids.
3. Ethnicity – Black women are more prone to develop fibroids than people of other colours. Also, the complications are higher in black women. Exact reason for this observation is yet to be figured. Medical experts are not yet sure if the fibroids in black women are due to genetics or diet or their lifestyle.
4. Hormone imbalance. Estrogen and progesterone play a major role in a woman’s body especially with organs related to reproduction. The regular and balanced increase or decrease in these hormones cause the menstrual cycle. When the balance of these hormones is disturbed (either by internal or external factors), that can affect the growth of endometrial layer and fibroids.
5. Being overweight or obese. Women who are overweight or obese are at higher risk of developing fertility problems including the development of fibroids. Regular exercise and change in food habits along with lifestyle will be recommended by gynecologists for people who fall in these categories.
6. Diet. It has been observed that higher intake of red meat, consumption of alcohol, deficiency of vitamin D can increase the risk of developing fibroids.
7. Number of children (parity). Higher the number of children a woman has given birth to, lower the risk of fibroids.

Diagnosis of Submucosal fibroids

A good gynecologist may detect the presence of fibroids during a physical examination or while diagnosing a different medical condition. This can happen when the fibroids are small and don’t show any symptoms. In case of larger fibroids, symptoms may give a hint to the doctor and then you may be asked to get any or some of the following tests done:

1. Ultrasound report
2. MRI (Magnetic Resonance Imaging) of the uterus (pelvic region)
3. CT Scan
4. Hysterosalpingogram (HSG) – The process involves injecting a chemical dye into the uterus and then taking an X-ray to get a clearer picture of the interiors of the uterus.
5. Sonohysterogram – Injecting water and then taking an ultrasound. This is similar to hysterosalpingogram.

If your doctor is performing a surgery for a different region using a laparoscope, he/she can use the same device to look for fibroids inside the uterus. In some cases, hysteroscope may be inserted through the vagina to look at the inner lining of the uterus for fibroids.