According to their position within the uterine wall, uterine fibroids are classified in three different types:
Subserosal Fibroids are located near the outer layer or serosa of the uterus. Because they grow more towards the outside of the uterus, small subserosal fibroids are less likely to cause significant symptoms.
So Small asymptomatic subserosal fibroids usually do not require any treatment and can be just monitored with regular ultrasounds. Larger fibroids can become symptomatic. More than menstrual symptoms it can cause pressure symptoms when it compresses on the surrounding organs like bowel or urinary bladder.
- Heaviness in abdomen
- Pressure symptoms over nearby organs, most commonly the bladder (increased urinary frequency, stress incontinence) and rectum (difficult motions/constipation).
Intramural fibroids are located predominantly within the width of the uterine muscle or myometrium.
They tend to behave like subserous fibroids, but depending on their size and position, can cause all the usual symptoms associated with fibroids:
- Heavy bleeding or extended periods
- Bleeding between menstrual cycle
- Infertility and miscarriages
- Pressure symptoms
Submucous fibroids grow towards the internal layer or mucosa of the uterus and protrude into the uterine cavity.
They tend to be symptomatic at smaller sizes, the main symptom being heavy and irregular bleeding.
Submucous fibroids are also more likely to impact fertility, both by making it difficult to fall pregnant and by causing miscarriages.
Though those 3 classifications are not perfect, and many a times women can have a combination of these fibroids, but it helps clinicians make the diagnosis and plan treatment.
The treatment is usually based on the predominant aspect of the fibroid, i.e., an intramural/subserosal fibroid with no submucosal component would require a laparoscopy for removal; an intramural fibroid with a significant submucosal portion can be treated by laparoscopy or hysteroscopy. Submucous fibroids can be removed through a hysteroscopy, a very non-invasive method and consideration for removal should be done early as soon as they are diagnosed.
Advanced Gynecological Laparoscopic Surgeon
Mediclinic Welcare Hospital, Mediclinic Parkview Hospital