Submucous leiomyoma is a type of uterine fibroid, common non-cancerous growths that develop within the uterus. A submucous leiomyoma specifically arises from the muscular wall of the uterus and grows directly beneath the endometrium, the inner lining of the uterine cavity. This particular location can significantly impact a person’s health and reproductive function.
Defining Submucous Leiomyoma
Submucous leiomyomas originate from the myometrium, the muscular layer of the uterus, but uniquely extend into the uterine cavity. This distinguishes them from other uterine fibroids, such as intramural fibroids within the uterine wall or subserosal fibroids on the outer surface. They can vary in size, from small growths to larger masses that can distort the uterine shape. Submucous fibroids are considered the least common type, yet often the most symptomatic due to their specific location.
Recognizing the Symptoms
Submucous leiomyomas are frequently associated with noticeable symptoms, even when relatively small. Their position within the uterine cavity can interfere with the normal shedding of the uterine lining, leading to heavy menstrual bleeding (menorrhagia). This excessive bleeding can result in prolonged periods, often lasting more than a week, and irregular bleeding between cycles.
Significant blood loss can lead to iron-deficiency anemia, causing fatigue, weakness, and dizziness. Individuals may also experience pelvic pain or pressure, ranging from a dull ache to sharp discomfort, and may be accompanied by large blood clots during menstruation.
Diagnostic Procedures
Diagnosing submucous leiomyomas begins with a medical history review and physical examination. A pelvic exam may reveal an enlarged or irregularly shaped uterus. Imaging studies then confirm the fibroids’ presence and characteristics.
Transvaginal ultrasound is often the initial diagnostic tool, providing clear images of the uterus. Saline-infusion sonography (SIS), also known as sonohysterography, involves introducing sterile saline into the uterus to expand the cavity, allowing for better identification of submucous fibroids. Hysteroscopy, using a thin, lighted telescope inserted through the cervix, allows direct visual inspection of the uterine cavity and fibroid. MRI may provide a comprehensive view, especially for larger or multiple fibroids, or to differentiate them from other growths.
Available Treatment Options
Medical management often focuses on controlling symptoms, particularly heavy bleeding. Hormonal therapies, such as gonadotropin-releasing hormone (GnRH) agonists, can temporarily shrink fibroids and reduce bleeding by inducing a temporary menopause-like state. Other medical options include oral contraceptives or progestin-releasing IUDs, which manage heavy menstrual flow and pelvic pain. These treatments address symptoms but do not eliminate fibroids, and symptoms often return after cessation.
Surgical intervention is often considered for definitive treatment. Hysteroscopic myomectomy is the preferred surgical method for removing submucous fibroids. This minimally invasive procedure involves resecting the fibroid through the vagina and cervix, avoiding abdominal incisions. For very large, numerous, or intramural fibroids, other surgical options include laparoscopic myomectomy, open abdominal myomectomy, or hysterectomy (removal of the uterus).
Effects on Fertility and Pregnancy
Submucous leiomyomas can significantly affect reproductive health due to their location within the uterine cavity. These fibroids can interfere with conception by distorting the uterine shape, which may impede sperm transport or prevent the successful implantation of an embryo into the uterine lining. Their presence is associated with lower rates of implantation and clinical pregnancy.
During pregnancy, submucous fibroids can lead to increased risks of complications. These include a higher likelihood of miscarriage and an elevated risk of preterm labor. They may also contribute to placental abruption or abnormal fetal presentation, which can complicate delivery. Surgical removal of submucous fibroids, specifically through hysteroscopic myomectomy, can improve fertility outcomes.