Uterine fibroids, also known as leiomyomas or myomas, are the most common non-cancerous growths found in the female reproductive system. These tumors are composed of smooth muscle cells and fibrous connective tissue, developing either within or on the wall of the uterus. Fibroids can vary enormously in size, from being tiny, undetectable nodules to large masses that can alter the shape of the uterus. While most women with fibroids never experience symptoms, the location and dimensions of these growths determine their potential impact on health.
The Phenomenon of Fibroid Expulsion
The question of whether a fibroid can physically pass out of the body is a direct concern for many patients, and the answer is yes, though it is an uncommon event. This process, clinically termed fibroid expulsion or prolapse, involves a fibroid detaching from the uterine wall and being pushed out. The fibroid travels downward from the uterine cavity, through the narrow opening of the cervix, and into the vaginal canal. This expulsion can occur spontaneously, or sometimes after treatments like Uterine Fibroid Embolization (UFE) that cut off the blood supply to the growth.
The mechanism that drives this event is the rhythmic, muscular contraction of the uterus, similar to the contractions experienced during labor or menstruation. The uterus recognizes the detached or partially detached fibroid as a foreign body it needs to be expelled. This intense, involuntary action of the smooth muscle tissue attempts to clear the uterine cavity. The fibroid may emerge partially, remaining tethered to the uterine wall, or detach completely and be passed entirely out of the body.
The Specific Fibroid Type Involved
For a fibroid to be expelled, it must first be located within the uterine cavity, making a specific type of growth the only one susceptible to this phenomenon. The fibroid must be a submucosal fibroid, meaning it is situated directly beneath the endometrium, the inner lining of the uterus. More specifically, the fibroid most likely to be expelled is a pedunculated submucosal fibroid.
This particular fibroid is attached to the uterine wall by a slender stalk, or peduncle, which provides its blood supply. When the uterus contracts, the force is directed at the base of this stalk, eventually leading to a loss of blood flow, tissue degeneration, and detachment. Other common fibroid types, such as intramural (within the muscular wall) or subserosal (on the outer surface), do not project into the cavity and cannot be expelled through the cervix. The degeneration of the fibroid tissue due to a lack of blood supply further weakens the attachment point, facilitating the final separation and passage.
Symptoms and Necessary Medical Intervention
Fibroid expulsion is often a distressing event, presenting with a distinct set of severe symptoms. Patients report intense, labor-like cramping that is far more severe than typical menstrual pain, reflecting the powerful uterine contractions pushing the mass through the cervical opening. This is usually accompanied by sudden and heavy vaginal bleeding, sometimes with the passage of large blood clots. In some cases, the patient may feel a mass protruding from the vagina.
If a fibroid is being expelled or has recently passed, it is necessary to seek immediate medical evaluation. The primary concern is controlling the bleeding, which can sometimes be significant, and preventing infection. A partially expelled fibroid that remains attached to the uterine wall can cause prolonged bleeding and is at risk of becoming necrotic and infected. The medical team will assess the situation, often confirming the diagnosis with a physical examination and ultrasound imaging.
Intervention is often required to safely remove the tissue, especially if the fibroid is partially detached and hanging from the cervix. For a prolapsed pedunculated submucosal fibroid, a simple vaginal myomectomy can be performed to sever the remaining stalk and remove the tissue. If the fibroid is still mostly within the uterine cavity, a hysteroscopic procedure may be necessary to visualize and remove the attached portion. Timely removal is essential to stop the bleeding, alleviate pain, and eliminate the risk of infection.