Sub Mucous Fibroids

Submucous fibroids and heavy bleeding

Fibroids cause different symptoms, sometimes they simply cause an enlarging lump in the pelvis, extending into the abdomen giving rise to what we call compression syndrome which is frequency of urination, bloating of the abdomen, distension of the stomach (with a cosmetically unsightly protuberance), sciatica, constipation and other symptoms. In other cases, fibroids cause very heavy bleeding leading to anaemia and debilitation. Sometimes both symptom patterns are present.

In this post we are going to talk specifically about submucous fibroids. These are fibroids which although developing in the wall, are very close to the endometrium and bulge into the cavity of the uterus to a variable degree. The problem with this type of fibroid is that they invariably cause very heavy periods: they grow under the influence of oestrogen and the periods get worse and worse, the anaemia becomes more and more problematical and the quality of life for the patient is progressively impaired. Gynaecologists may try treatments such as the Mirena coil or endometrial ablation where the lining of the womb is burned off, but these rarely or never work in the case of submucous fibroids. The best treatment for these fibroids, if they are not small and cannot be resected hysteroscopically, is fibroid embolisation. This procedure is very rapidly effective, the fibroid is killed and shrinks and patients normally feel completely cured within three months of the procedure.

Sometimes, these submucous fibroid detach from the wall of the uterus and the uterus starts to contract to pass them out. Because these fibroids are dead, they can be easily removed hysteroscopically leaving the patient, if that is the only problem, with a normal uterus. In the main though these fibroids will simply die and shrink. The success rate of fibroid embolisation in these patients (plus or minus hysteroscopic resection) is well over 95%. Very often I see patients who have staggered on with these symptoms, in some cases having multiple blood transfusions, because they have only been offered hysterectomy by the gynaecologist. These patients are rapidly cured by embolisation and are always very pleased with the procedure and wonder why they did not have it before.

The moral of the story is: If you have this type of fibroid, which can be easily classified on ultrasound or MRI study, don’t delay treatment and, unless that fibroid is very small and can be resected easily hysteroscopically, fibroid embolisation is rapidly curative and life transforming.