Last updated: Oct 24, 2024Published on: May 24, 2023
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Introduction
In this blog, we will explore the characteristics of intramural fibroids and delve into various aspects related to their diagnosis and treatment, providing valuable insights for those seeking information and clarity. Uterine fibroids, or abnormal growth in the uterus, can occur in various locations and sizes. They can be as small as 1 mm or as large as 20 cm or even more. This blog focuses on intramural fibroids, which are the most common type. Women between the ages of 30 and 50 are particularly prone to developing fibroids.1
Signs and Symptoms of Intramural Fibroid
Some persons with fibroids never display any signs or have any issues. 1 Usually these are of very small size, but those with larger-sized fibroids will show symptoms such as:
Excessive or irregular bleeding during your menstrual cycle
Feeling bloated or experiencing a sensation of fullness in the lower abdomen
Frequent urination (a fibroid tumour can cause strain on your bladder)
Discomfort during intercourse
A sore back
Constipation
Persistent vaginal leaking
Abdominal expansion and increased bloating that gives you a pregnant-looking belly.1
When to See a Doctor
Although fibroids are non-cancerous in nature, one must be aware of the enlisted symptoms and consider visiting the doctor to rule out all complications. 1
If you are experiencing heavy menstrual bleeding, pain or discomfort in the pelvic area, or frequent urination, heavy menstrual bleeding, often causing severe anaemia, along with pelvic pain, pressure, infertility, and other distressing complications.6
If you have been trying to conceive and have not been successful, or if you have had multiple miscarriages, it is also important to take a consultation with a doctor to rule out any connection between the fibroids and pregnancy-related complications.2
If you are postmenopausal and have been diagnosed with intramural fibroids, it is important to see a doctor to rule out the possibility of cancerous growths.
In general, if you have been diagnosed with intramural fibroids, it is a good idea to speak with a doctor to discuss your treatment options. Depending on the severity of your symptoms and your personal medical history, your doctor may recommend watchful waiting, medication, or surgery.
Medications involving gonadotropin-releasing hormone (GnRH) may aid in reducing intramural fibroids. They may occasionally be used to reduce the size of a fibroid before surgery, making it simpler to remove. I strongly recommend one should immediately consult a doctor and avoid any self-medication.
The exact cause of fibroids is unknown. However, they are believed to be influenced by hormones in the body and may also have a genetic component, potentially running in families.3
Hormone: The female reproductive hormone—oestrogen—is created by the ovaries, which are the female reproductive organs.
During a female’s reproductive years (from approximately 16 to 50), while oestrogen ranges are at their height, fibroids usually appear. 3
Role of Genetics: The precise mechanisms by which genes contribute to the development of intramural fibroids are not fully understood. However, it is believed that certain genetic factors can make individuals more susceptible to developing fibroids4
Risk Factors for Intramural Fibroid
Your likelihood of having intramural fibroids may be influenced by several risk factors that are as follows:
Age: The likelihood of developing fibroids increases as women get older, particularly during their 30s and 40s until menopause. Fibroids tend to shrink after menopause.
Family history: Having a family member with fibroids raises the risk. If a woman’s mother had fibroids, her risk of developing them is about three times greater than the average risk.
Ethnicity: African-American women have a higher likelihood of developing fibroids compared to white women.
Obesity: Obesity is a risk factor for fibroids, and the risk is further elevated for women who are high waist-hip circumference ratio, with a two to three times higher risk compared to the average.
Dietary habits: Consuming a significant amount of red meat (e.g., mutton, beef) and ham is associated with a higher risk of fibroids. Conversely, having a diet rich in green vegetables appears to provide protection against developing fibroids.1
Diagnosis of Intramural Fibroid
The diagnosis of intramural fibroids often begins with a thorough evaluation by a healthcare provider. The diagnosis includes the following: 1
Medical history: Often, when you describe symptoms like heavy bleeding and other related issues, it prompts your healthcare provider to consider fibroids as a potential part of the diagnosis.
Physical examination: In many instances, fibroids are initially detected during a routine examination with your healthcare provider. They can be felt during a pelvic exam or identified through gynaecologic exams or prenatal care.
Investigation performed using several tests:
Ultrasonography: This painless imaging test uses sound waves to create images of your organs. It can be performed either by placing a device on your abdomen or by inserting a probe into your vagina.
Magnetic resonance imaging (MRI): It is a diagnostic test that utilizes the power of magnets and radio waves to create highly detailed images of the internal organs within your body.
Computed tomography (CT): A CT scan uses X-rays to create detailed images of your organs from different angles.
Hysteroscopy: During this procedure, a thin tube with a camera is inserted through your vagina and cervix to examine the fibroids inside your uterus.
Hysterosalpingography (HSG): This X-ray test involves injecting a contrast material into the uterus to evaluate its structure. It is often used in infertility evaluations.
Sono-hysterography: This imaging test involves injecting saline into the uterus to create clearer images during an ultrasound examination.
Laparoscopy: In this procedure, a small incision is made in your abdomen, and a thin tube with a camera is inserted to examine your internal organs.
Treatment of Intramural Fibroid
Treatment options for uterine fibroids depend on factors like size, number, location, and symptoms.
If you have no symptoms, small fibroids can be left untreated, with regular monitoring through pelvic exams and ultrasound.
Symptoms such as anaemia, pain, infertility, or urinary/bowel problems often require treatment.
The treatment plan considers the number, size, and location of fibroids, the symptoms, the desire for pregnancy, and the desire to preserve the uterus.1
The most suitable treatment option for you will depend on your future fertility goals, as certain treatments may impact your ability to have children.
Discuss your thoughts on fertility and future goals with your healthcare provider when exploring treatment options.
Treatment options for uterine fibroids may encompass a range of approaches, which can include
Medications like over-the-counter pain medications, iron supplements, and birth control methods.
Birth control can help manage symptoms like heavy bleeding and menstrual cramps.
Gonadotropin-releasing hormone (GnRH) promoter can shrink fibroids temporarily and are sometimes used before surgery to facilitate removal.1
Surgical options for fibroids –
When discussing surgery options for fibroid removal, several factors come into play. The size, location, and number of fibroids can influence the type of surgery.
Additionally, your desire for future pregnancies is an important consideration in developing a treatment plan.
Certain surgical options aim to preserve the uterus and maintain the possibility of future pregnancy, while others may involve removing or damaging the uterus.
Myomectomy
Other surgery options
Myomectomy is a surgical procedure that enables the removal of fibroids while preserving the uterus.1There are various types of myomectomy, and the most suitable procedure for you will depend on the size, location, and number of fibroids. The types of myomectomy procedures for removing fibroids can include:Hysteroscopy: In this medical procedure there is insertion of a slender and flexible instrument known as a hysteroscope through the vaginal opening and cervix, allowing access to the uterus. Laparoscopy: This procedure involves using an endoscope to remove the fibroids. Unlike hysteroscopy, it requires a few small incisions in the abdomen for the scope to enter and exit. Robotic assistance may also be used for this procedure. Laparotomy: This procedure involves making a larger incision in the abdomen to remove the fibroids.1
If you do not plan on having future pregnancies, there are additional surgical options that your healthcare provider may suggest. However, these options are not recommended if you desire to have children, as they involve removing the uterus. These surgeries can be highly effective but will prevent future pregnancies. Surgical options to remove fibroids include1:Hysterectomy: This surgery removes the uterus, providing a permanent solution for fibroids. With the uterus gone, fibroids cannot come back, and symptoms should go away. Uterine fibroid embolization: This procedure is performed by a specialized radiologist and gynecologist working together. It involves inserting a small tube into the blood vessels that supply the fibroids and blocking them with tiny particles. By reducing the blood flow to the fibroids, they shrink, leading to symptom improvement. Radiofrequency ablation (RFA): RFA is a safe and effective treatment for women experiencing symptoms from uterine fibroids. It can be performed using minimally invasive techniques such as laparoscopy, transvaginal, or transcervical approaches.1
In particular, excessive menstrual bleeding and menstrual discomfort, which are signs of intramural fibroids, may be managed with birth control aids. The usage of birth control is believed to reduce excessive menstrual bleeding. Oral contraceptive tablets, intravaginal contraceptives, injections, and intrauterine devices (IUDs) are just a few of the birth control methods available. I suggest consulting your doctor before using any intervention.
In general, fibroids cannot be prevented. However, one can lower risk of developing fibroids –
By maintaining a healthy body weight and being physically active.
Obtaining frequent pelvic check-ups.
One can create a monitoring strategy with their doctor if you have tiny fibroids.1
According to Dr. Billow, a comprehensive analysis revealed that individuals who consumed more fruits and vegetables had a lower risk of developing fibroids.
According to the study findings, individuals who consumed four servings of food daily had a lower risk of developing fibroids compared to those who consumed only one serving per day.
While all fruits and vegetables offer significant health benefits, certain types have shown effectiveness in combating fibroids.
These include apples, broccoli, cabbage, citrus fruits such as oranges, lemons, and grapefruit, and tomatoes.7
There is evidence suggesting that meeting the recommended intake of vitamin D can reduce the risk of developing fibroids. To ensure an adequate intake of vitamin D, you can include the following food sources in your diet:
Fortified dairy products such as milk and yogurt
Fortified dairy alternatives like soy, almond, coconut, or oat milk or yogurt
Tuna
Salmon.7
Complications of Intramural Fibroid
Every form of treatment carries some risk. Before beginning a new medicine, discuss with your healthcare practitioner all medications you may be taking for other medical issues as well as your whole medical history. Call your provider to go over your alternatives if you start a new medicine and have side effects.
Risks are also always present when treating fibroids surgically.1
You run the risk of bleeding, infection, and other dangers related to surgery and anaesthesia with any procedure.
Future pregnancies are a potential added risk of fibroid removal operation. A few surgical procedures can stop future pregnancies (infertility).
A treatment called a myomectomy merely removes the fibroids, enabling future pregnancies. However, those who have undergone a myomectomy might require a Caesarean section to deliver any future children.1
In one of the studies involving 180 women, it was found that 52.2% of them became pregnant after undergoing myomectomy (fibroid removal surgery).8
The results showed that women who were above the age of 35 had a 0.31 times lower likelihood of getting pregnant after the surgery compared to women between the ages of 20-25.8
Premature labour is a possibility for women who have fibroids and may have belly (abdominal) pain throughout pregnancy.
Fibroids can occasionally result in miscarriage.2
Research Facts About Intramural Fibroid
Fibroids are most frequently found in women who are in their 40s and early 50s.1,5
Fibroids are typically non-cancerous (benign) in nature.1,5
African American women experience them more frequently than White, Hispanic, or Asian women do.4
Frequently Asked Questions (FAQs)
Will fibroids naturally disappear?
Some people may experience fibroids shrinking after menopause which is possibly due to a drop in hormone levels.1
Can fibroids lead to anaemia?
People who experience regular or exceptionally heavy periods are at risk for anaemia. If you have fibroids, it can make your periods quite heavy.1
Do fibroids have the ability to become cancerous?
It is incredibly uncommon for a fibroid to undergo modifications that cause it to develop into a cancerous or malignant tumour.1
How do fibroids look in appearance?
They are usually spherical growths; fibroids can look like lumps of smooth muscle.1
Can someone with intramural fibroids conceive?
Intramural fibroids do not interfere in becoming pregnant. Following fibroids therapy, most patients can conceive.1
Navarro A, Bariani MV, Yang Q, Al-Hendy A. Understanding the impact of uterine fibroids on human endometrium function [Internet]. Frontiers in cell and developmental biology. U.S. National Library of Medicine; 2021 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186666/
Jeldu M, Asres T, Arusi T, Gutulo MG. Pregnancy rate after myomectomy and associated factors among reproductive age women who had myomectomy at Saint Paul’s Hospital Millennium Medical College, Addis Ababa: Retrospective cross-sectional study [Internet]. International journal of reproductive medicine. U.S. National Library of Medicine; 2021. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8645378/
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