Uterine fibroids are common, non-cancerous growths that can develop within or on the uterus. While many women have fibroids without experiencing symptoms, these growths can sometimes lead to discomfort or other issues. Among the various types of fibroids, the “pedunculated” fibroid is distinct due to its unique anatomical attachment.
What Makes a Fibroid Pedunculated
A pedunculated fibroid is characterized by its attachment to the uterus via a slender stalk or stem, known as a peduncle. This feature differentiates it from other fibroid types, such as intramural fibroids that grow within the uterine wall, or subserosal fibroids that develop on the outer surface without a stalk. Peduncles are composed of the same smooth muscle as the fibroids themselves and can vary in size, ranging from 5 mm to 10 cm in diameter.
These fibroids can originate from different parts of the uterus. When a pedunculated fibroid grows from the outer wall of the uterus and projects into the abdominal cavity, it is termed a pedunculated subserosal fibroid. Conversely, if it develops from the inner lining of the uterus and extends into the uterine cavity, it is known as a pedunculated submucosal fibroid. Their appearance is often likened to a mushroom due to the distinct stalk and wider top.
Common Symptoms
However, their unique stalk-like attachment can lead to specific issues. One notable symptom is sudden, sharp abdominal pain, which can occur if the fibroid twists on its stalk, a condition known as torsion. This twisting can cut off the fibroid’s blood supply, leading to acute pain that requires immediate medical attention.
General fibroid symptoms can also manifest, including heavy or prolonged menstrual bleeding, spotting between periods, and pelvic or abdominal pain. The size and location of the pedunculated fibroid can also contribute to pressure symptoms on surrounding organs, such as the bladder, leading to frequent urination, or the rectum, causing constipation. Submucosal pedunculated fibroids are more commonly associated with heavy bleeding and fertility concerns, while subserosal ones tend to cause abdominal pressure and pain.
Diagnosis and Treatment Approaches
Diagnosing pedunculated fibroids often involves a pelvic exam, often revealing growths. Imaging techniques are important for confirmation and to determine the fibroid’s size, location, and number. A transvaginal ultrasound is a common non-invasive method that provides detailed images of the uterus and fibroids. For more detailed views, Magnetic Resonance Imaging (MRI) may be used, especially for larger or complex cases. Hysteroscopy or laparoscopy might also be used for direct visualization.
Treatment for pedunculated fibroids varies based on symptoms, size, location, and a woman’s desire for future fertility. For asymptomatic fibroids, observation through regular monitoring may be recommended. Medical management can address symptoms, including over-the-counter pain relievers for discomfort or hormonal therapies to help manage heavy bleeding. These medications can help alleviate symptoms but do not eliminate the fibroids.
Surgical intervention is often considered for symptomatic pedunculated fibroids. Myomectomy, a procedure to remove the fibroid while preserving the uterus, is frequently chosen, particularly for women who wish to maintain fertility. The presence of a stalk can sometimes make surgical removal of pedunculated fibroids more straightforward compared to other types. Hysterectomy, removal of the entire uterus, is an option for severe symptoms or when other treatments fail and future pregnancy is not desired. Minimally invasive procedures like uterine artery embolization (UAE), which cuts off blood flow to fibroids, may also be considered.
When to Consult a Doctor
Consult a doctor for persistent or worsening pelvic symptoms. These include unusually heavy or prolonged menstrual bleeding, spotting between periods, or chronic pelvic pain. Sudden, severe abdominal or pelvic pain, possibly indicating fibroid torsion, warrants immediate medical attention.
Concerns about fertility or difficulty conceiving also warrant a visit, as fibroids can impact reproductive health. Routine gynecological check-ups are important, as fibroids may be discovered incidentally. Timely medical advice ensures proper diagnosis and management options.