Uterine fibroids are common, non-cancerous growths that develop within the uterus. They are also known as leiomyomas or myomas. These growths vary in size, from a seed to a grapefruit or larger, and can occur as single nodules or in clusters. While many people with fibroids experience no symptoms, others face various health concerns.
What Are Intramural Fibroids?
Intramural fibroids are the most prevalent type of uterine fibroid. These benign growths develop within the muscular wall of the uterus, the myometrium, embedded in its thick tissue.
Unlike subserosal fibroids (outer surface) or submucosal fibroids (uterine cavity), intramural fibroids are contained within the uterine muscle. Their location can distort the uterine cavity or alter the uterus’s external shape as they grow. Intramural fibroids are typically diagnosed between the ages of 30 and 40, though they can emerge at any age.
Recognizing the Signs
Symptoms vary widely by fibroid size, number, and location within the uterine wall. Smaller fibroids often go undetected, causing no noticeable symptoms. Larger or multiple fibroids, however, can cause disruptive signs.
Common symptoms include prolonged heavy menstrual bleeding, sometimes leading to anemia. Pelvic pain or pressure, abdominal fullness, or discomfort during sexual activity may also occur. Pressure on surrounding organs can cause frequent urination, difficulty emptying the bladder, or lower back and leg pain.
Understanding Causes and Risk Factors
The precise cause of intramural fibroids is not fully understood, but research suggests multiple contributing factors. Hormonal influences, particularly estrogen and progesterone, play a significant role. These menstrual cycle-regulating hormones stimulate fibroid growth, shrinking after menopause when hormone levels decrease.
Risk factors include age, with fibroids more common during reproductive years. A family history also increases risk, suggesting genetic predisposition. African American women have a higher incidence, often developing them younger with more severe symptoms and larger growths. Obesity and certain dietary factors may also contribute.
Navigating Diagnosis and Treatment Options
Intramural fibroids are often discovered during routine pelvic exams or imaging tests. Ultrasound is the primary diagnostic tool, providing detailed information on fibroid size, location, and number. For a more comprehensive view, especially when considering treatments, an MRI scan may be used.
Treatment varies by symptoms, fibroid size, location, and individual preferences, including future pregnancy plans. Options include:
Watchful waiting for asymptomatic cases.
Medical management with hormonal therapies (e.g., GnRH agonists) to temporarily shrink fibroids.
Surgical myomectomy (fibroid removal preserving the uterus) or hysterectomy (complete uterus removal).
Uterine artery embolization (UFE) to block blood flow and shrink fibroids.
Impact on Reproductive Health
Intramural fibroids can influence reproductive health, posing challenges for conception and pregnancy. Large fibroids, especially those distorting the uterine cavity, may impede fertility by altering uterine shape, affecting sperm movement or embryo implantation.
During pregnancy, intramural fibroids may increase complication risks, including miscarriage, preterm labor, or placental development issues. They can also contribute to fetal malpresentation or necessitate a C-section delivery. Myomectomy, which removes fibroids while preserving the uterus, is often considered to improve fertility outcomes.