Uterine fibroids (leiomyomas or myomas) are common, non-cancerous muscular growths that develop within the wall of the uterus. While most growths remain in place, some can spontaneously detach and be pushed out through the vagina. This event, known as fibroid expulsion, can be alarming and is often mistaken for a miscarriage or severe menstrual event. The process of passing the tissue carries risks and may lead to acute complications requiring immediate medical attention. This article assesses the specific dangers and necessary medical responses associated with fibroid expulsion.
Mechanisms of Fibroid Expulsion
Fibroid expulsion is a physical process where the uterus contracts forcefully to detach and push the mass through the cervical canal and into the vaginal space. This mechanism is most frequently observed with specific types of fibroids due to their location and attachment structure. Submucosal fibroids, which develop just beneath the inner lining of the uterus, are the most likely candidates for expulsion because they push into the uterine cavity.
Pedunculated fibroids, attached by a thin stalk (pedicle), are also prone to expulsion. Detachment often begins when the fibroid undergoes necrosis, meaning it loses its blood supply and the tissue starts to die. The uterus recognizes this necrotic mass as foreign tissue and initiates strong, involuntary contractions to expel it.
These contractions are frequently described as labor-like due to their intensity and rhythmic nature, as the cervix must dilate to allow the fibroid to pass. The process can occur spontaneously, sometimes during or just after menstruation, or it can be a delayed effect following treatments like Uterine Fibroid Embolization (UFE). Expulsion can happen over a period of hours, or the tissue may be passed in fragments over several days or weeks.
Acute Symptoms and Potential Complications
The expulsion of a fibroid presents acute symptoms, with the most significant immediate risk being severe hemorrhage, defined as rapid and excessive blood loss. While heavy bleeding is common, a flow that soaks through one or more sanitary pads or tampons every hour for several consecutive hours warrants emergency care. This profuse bleeding can lead to acute anemia or hypovolemic shock, posing a serious threat to stability.
Another major complication is the risk of infection, especially if the fibroid is only partially expelled or if necrotic tissue is retained within the uterine cavity. Decaying tissue provides an ideal environment for bacterial growth, which can lead to endometritis or, in rare cases, sepsis. Signs of a developing infection include a persistent fever, chills, and a foul-smelling vaginal discharge.
Although intense cramping is expected during the expulsion process, pain that is excessively severe or unrelenting requires immediate medical evaluation. A partially detached mass can also cause the cervix to remain open, increasing the pathway for ascending bacterial infection into the uterus. Any symptom suggesting an incomplete expulsion or systemic infection requires prompt medical intervention.
Medical Intervention and Follow-Up Care
If fibroid expulsion is suspected, seeking immediate medical evaluation is necessary, even if bleeding appears controlled. A healthcare professional will perform a physical examination, including a pelvic exam, to assess the extent of the expulsion. Diagnostic imaging, typically a transvaginal ultrasound, determines if the fibroid was fully expelled or if any tissue remains in the uterus.
If imaging reveals partially passed or attached tissue, intervention is required to complete the process and prevent infection or continued bleeding. Procedures such as hysteroscopic fibroid resection or operative transvaginal myomectomy may be performed to safely remove the fragments. In cases of severe hemorrhage or cervical obstruction, dilation and curettage (D&C) might be necessary to evacuate the mass.
Following the acute event, follow-up care monitors the patient’s recovery and addresses the underlying condition that led to the fibroid growth. This involves monitoring for signs of continued infection and planning to manage other existing fibroids to prevent future expulsions. A comprehensive management strategy is necessary to ensure long-term uterine health.