Is the location of my fibroid important?

One of the most important factors to consider when diagnosing and treating fibroids is their location; the position of a fibroid within the uterus can affect the symptoms it causes, the treatment options available, and even the risk of complications during pregnancy.

Miss Natalie Nunes, leading consultant gynaecologist, explores the importance of fibroid location and how it impacts symptoms, fertility, pregnancy, and treatment options.

What are the most common locations where fibroids can develop?

Fibroids can develop in several different areas within or around the uterus:

• Submucosal fibroids: These fibroids grow beneath the lining of the uterus. They protrude into the uterine cavity and can affect the uterus' ability to shed its lining properly. These fibroids can cause significantly heavy painful periods even at a very small size.
• Intramural fibroids: These fibroids develop within the uterine muscle wall. They are the most common type and can often go unnoticed until they grow large. These fibroids can also cause significantly heavy painful periods but tend to do so at a larger size before you notice the change in your symptoms.
• Subserosal fibroids: These fibroids form on the outer surface of the uterus, pressing outward towards the abdominal cavity. They can become quite large without affecting the inside of the uterus. These fibroids are more likely to cause pressure symptoms like needing to wee more often, constipation, back pain, bloating or protrusion of your tummy.
• Other locations: Fibroids can also be found in the wall of the cervix, within the ligaments of the uterus or even attached to other organs in your pelvis. An ultrasound scan during or after a consultation can check for the location of the fibroid and how it moves to help determine if it is attached to these other organs.

How does the location of a fibroid influence its symptoms?

The symptoms caused by fibroids can vary greatly depending on their location. While some fibroids may remain asymptomatic for a long time, others can lead to significant health issues.

Submucosal fibroids, for example, are more likely to cause heavy or prolonged menstrual bleeding. They can also lead to painful periods and may cause a feeling of fullness or pressure in the pelvic area.

Similarly, intramural fibroids can also cause changes in menstrual patterns, such as longer or more painful periods. Additionally, they may lead to back pain, bloating, or constipation, especially if they grow large enough or they press on nearby organs.

Subserosal and the ‘other’ fibroids are less likely to cause significant bleeding or affect menstruation. However, they may lead to a sensation of fullness or bloating in the abdomen, and large subserosal fibroids may also cause pain or discomfort if they press against surrounding organs.

Can fibroids in certain locations impact fertility / pregnancy?

Yes, fibroids in certain locations can have a significant impact on fertility and pregnancy.

Submucosal fibroids are the most likely to interfere with fertility due to their position. These fibroids can alter the shape of the uterine cavity, making it harder for a fertilised egg to implant. For pregnant women, they can also increase the risk of miscarriage or early pregnancy loss.

Intramural fibroids can equally impact fertility, especially if they are large or located in certain areas. They can change the shape of the uterus, disrupt the normal contractions of the uterine muscles, and affect the ability of sperm to reach the egg. Large intramural fibroids can contribute to early preterm labour and excessive bleeding after the birth of the baby.

While subserosal and ‘other’ fibroids are less likely to directly affect fertility, they can still cause complications. If large enough, they can cause mechanical problems, compressing the fallopian tubes or impacting blood flow to the uterus and making conception more challenging. They can also contribute to early preterm labour and excessive bleeding after birth like the intramural fibroids.

If you’re planning a pregnancy, or have fibroids and are concerned about fertility, it’s important to consult with your gynaecologist to discuss your options.

Is the location of my fibroid important for treatment?

The location of a fibroid is a key factor in determining the best treatment approach. For example, submucosal fibroids are more likely to require treatment due to their impact on menstruation and fertility. Sonata® Transcervical Ultrasound-guided Radiofrequency Fibroid Ablation is an incisionless option which can be used to shrink all 3 types of fibroids: submucous, intramural and subserous fibroid. Some submucous fibroids can be treated with a hysteroscopic myomectomy, which removes the fibroid through the cervix.

Intramural fibroids can be managed with medications to alleviate symptoms, but they work only as long as you continue taking the medication. An alternative is a myomectomy, which removes the fibroid either through an abdominal incision or using laparoscopy. For women who prefer to avoid surgery, Sonata® Transcervical Ultrasound-guided Radiofrequency Fibroid Ablation may be an ideal option and for those who are not planning any future pregnancies uterine artery embolisation can be an option to shrink the fibroid.

If subserosal fibroids need treatment, options include Sonata® Transcervical Ultrasound-guided Radiofrequency Fibroid Ablation, medications, uterine artery embolisation, or laparoscopic or robotic surgery to remove the fibroid.

Depending on hormonal changes, fibroids will naturally grow larger over time and tend to shrink after the menopause if hormone replacement therapy (HRT) is not used. Regular monitoring is essential to track the fibroid’s growth and determine when, and if, treatment is needed and the best timing of this treatment to afford you the most minimally invasive option and the option with the least risk factors.

To book an appointment with Miss Natalie Nunes, head on over to her Top Doctors profile today.