Uterine fibroids, also known as leiomyomas or myomas, are common non-cancerous growths that develop in or around the uterus. These benign tumors are frequently observed in individuals during their reproductive years, with estimates suggesting that between 20% and 80% of women may develop them by age 50. While many fibroids remain small and cause no noticeable issues, others can grow significantly, leading to various symptoms that impact quality of life.
Understanding Exophytic Fibroids
Exophytic fibroids are a specific type of uterine fibroid characterized by their outward growth from the surface of the uterus. This outward projection distinguishes them from intramural fibroids, which are embedded within the muscular uterine wall.
Exophytic fibroids can manifest in two primary forms: subserosal and submucosal. Subserosal fibroids grow from the outer wall of the uterus, extending into the abdominal or pelvic cavity. Submucosal fibroids, while less common, originate from the inner surface of the uterine wall and project into the uterine cavity.
A distinct characteristic of some exophytic fibroids is their attachment via a pedicle or stalk, at which point they are referred to as pedunculated fibroids. This stalk allows the fibroid mass to grow at its end. In rare instances, a pedunculated fibroid can detach from the uterus and establish a new blood supply from nearby structures, becoming a “parasitic leiomyoma.”
Recognizing Symptoms
Exophytic fibroids can lead to a range of symptoms, particularly as they increase in size or press on adjacent organs. Pelvic pain and a sensation of pressure are commonly reported, often described as a feeling of fullness in the lower abdomen. This pressure can extend to other areas, sometimes causing lower back pain or leg pains if the fibroid compresses nerves.
When exophytic fibroids exert pressure on the bladder, individuals may experience increased urinary frequency or difficulty completely emptying the bladder. Pressure on the rectum can result in constipation or a feeling of rectal pressure. Large exophytic fibroids are more likely to trigger abdominal bloating and discomfort due to their extension into the abdominal cavity.
While not unique to exophytic types, fibroids can contribute to menstrual changes such as heavier or prolonged periods and bleeding between cycles. These symptoms can lead to secondary issues like anemia and fatigue. Some individuals with exophytic fibroids may also report pain during sexual intercourse.
How Exophytic Fibroids Are Diagnosed
The diagnostic process for exophytic fibroids begins with a review of symptoms and a physical examination. If fibroids are suspected, imaging studies are then used to confirm their presence, size, location, and type. Ultrasonography is the initial imaging modality due to its accessibility and effectiveness. Both transabdominal and transvaginal ultrasound can be utilized, with transvaginal ultrasound offering greater sensitivity for smaller fibroids.
Magnetic Resonance Imaging (MRI) provides a more detailed view and is highly accurate for characterizing and localizing uterine fibroids. MRI offers clearer images, showing multiple views of the fibroids and providing information on their size, number, and exact location. This advanced imaging can help differentiate exophytic fibroids from other pelvic masses, such as ovarian tumors, which can appear similar on ultrasound.
In some cases, a hysteroscopy might be performed, especially if submucosal exophytic fibroids are suspected. This procedure involves inserting a thin, lighted tool with a camera into the uterus through the vagina and cervix to visualize the uterine cavity. For fibroids growing on the outer surface of the uterus, a laparoscopy, which involves a small incision and a camera, can be used to directly visualize the growths.
Treatment Options
The approach to managing exophytic fibroids depends on the fibroid’s size, location, symptom severity, and the individual’s desire for future fertility. For those with asymptomatic fibroids, watchful waiting may be recommended. Pain management medications can help alleviate discomfort.
Medical therapies may involve hormonal birth control to manage heavy bleeding, or gonadotropin-releasing hormone (GnRH) agonists, which can temporarily shrink fibroids by reducing estrogen levels. Progestin-releasing intrauterine devices (IUDs) can also help control bleeding. These medical options aim to alleviate symptoms rather than eliminate the fibroids themselves.
Surgical interventions offer more definitive solutions. Myomectomy is a procedure that surgically removes fibroids while preserving the uterus, making it an option for individuals who wish to maintain fertility. This can be performed through open abdominal surgery, laparoscopically, or hysteroscopically, depending on the fibroid’s characteristics. Hysterectomy, the complete surgical removal of the uterus, is another option, considered when other treatments have not been effective or if fertility preservation is not a concern.
Minimally invasive procedures are also available. Uterine fibroid embolization (UFE) involves blocking the blood supply to the fibroids, causing them to shrink. MRI-guided focused ultrasound surgery is a non-invasive technique that uses sound waves to destroy fibroid tissue, preserving the uterus without incisions. Radiofrequency ablation and cryoablation are additional methods that destroy fibroid tissue.