What Is an Intramural Fibroid?

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Intramural fibroids are growths that appear in the muscular wall of the uterus and are the most common type of uterine fibroid. Fibroids are almost always benign (not cancerous). Due to the location of intramural fibroids, they may grow large and can stretch the womb.

Uterine fibroid tumors, also known as fibroids or leiomyomas, are fairly common, affecting between 20% and 80% of all people with a uterus.

Learn more about intramural fibroids, including their causes, how they are diagnosed, and how they are treated.

Intramural Fibroid Symptoms

Verywell / Jessica Olah

Intramural Fibroid Symptoms

Many people who have fibroids don't have any symptoms. If you do have symptoms, these can be influenced by the location, size, and number of fibroids you have. Intramural fibroids have symptoms similar to those of other fibroid types.

You may experience:

Intramural Fibroids and Fertility

While many people with fibroids don’t experience fertility issues, the location and size of certain fibroids may cause fertility complications. Studies have linked having intramural fibroids with adverse pregnancy outcomes in people with a uterus undergoing in vitro fertilization (IVF) treatment.

Causes

The exact cause of fibroids is unknown, but they have been linked to the hormone estrogen. Fibroids usually develop during the reproductive years, when estrogen levels are at their highest.

Fibroids tend to shrink when estrogen levels are low, such as after menopause when monthly periods stop.

There are certain factors that increase your risk of developing uterine fibroids, including:

  • Age: Fibroids are most common between the ages of 40 and 50. They are uncommon before the age of 20.
  • Race: Fibroids are much more common in Black people. In addition to occurring more frequently, they often grow more quickly.
  • Obesity: Obesity may be linked to fibroids, but more research is needed in this area.
  • Family history: You are at an increased risk of developing fibroids if other people in your family have or have had fibroids.
  • Pregnancy history: There is an association between never being pregnant and developing fibroids.

Prevention

In general, you can’t prevent fibroids. If you fall into one or more of the risk categories, schedule regular checkups with your OB-GYN. They may be able to catch small fibroids before they impact your daily life.

Diagnosis

The first signs of fibroids may be detected during a routine pelvic examination. A number of tests may show more information about fibroids.

Your doctor can do imaging tests to confirm that you have fibroids. These tests might include:

  • Ultrasound: This imaging test creates a picture of your internal organs with sound waves. Depending on the size of the uterus, the ultrasound may be performed via your abdomen (transabdominal) or by inserting an ultrasound probe into your vagina (transvaginal ultrasound).
  • Magnetic resonance imaging (MRI): This test creates detailed images of your internal organs by using magnets and radio waves.
  • Computed tomography scan (CT): A CT scan uses X-ray images to make a detailed image of your internal organs from several angles.
  • Hysterosalpingogram (HSG) or sonohysterogram: An HSG involves injecting X-ray dye into the uterus and taking X-ray pictures. A sonohysterogram involves injecting water into the uterus and making ultrasound pictures.

You might also need surgery to know for sure if you have fibroids. There are two types of surgery for this:

  • Laparoscopy: During this test, your provider will make a small cut (incision) in your lower abdomen. A thin and flexible tube with a camera on the end will be inserted to look closely at your internal organs.
  • Hysteroscopy: The doctor passes a long, thin scope with a light through the vagina and cervix into the uterus. No incision is needed. The doctor can look inside the uterus for fibroids and other problems, such as polyps.

Treatment

Talk with your doctor about the best way to treat your fibroids. They will consider many things before helping you choose a treatment, including:

  • Whether or not you have symptoms
  • If you might want to become pregnant in the future
  • The size of the fibroids
  • The location of the fibroids
  • Your age and how close to menopause you may be

Medications

If you have fibroids, your doctor may suggest taking medication.

  • Over-the-counter drugs: Drugs such as ibuprofen or acetaminophen can address pain. If you have heavy bleeding during your period, an iron supplement can keep you from getting anemia.
  • Hormonal birth control methods: These are often used to control heavy bleeding and painful periods.
  • Progestin–releasing intrauterine device (IUD): This is an option for people with fibroids that do not distort the inside of the uterus. It reduces heavy and painful bleeding but does not treat the fibroids themselves.
  • Gonadotropin-releasing hormone (GnRH) agonists: These drugs stop the menstrual cycle and can shrink fibroids. They are sometimes used before surgery to make fibroids easier to remove.
  • Antihormonal agents or hormone modulators (such as selective progesterone receptor modulators): These drugs—which include ulipristal acetate, mifepristone, and letrozole—can slow or stop the growth of fibroids, reduce bleeding, and improve symptoms.

Surgery

If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:

  • Myomectomy: Surgery to remove fibroids while preserving the uterus. It is best for those who wish to have children after treatment for their fibroids or want to keep their uterus for other reasons.
  • Hysterectomy: Surgery to remove the uterus. This surgery is the only sure way to cure uterine fibroids. Fibroids are the most common reason hysterectomy is performed.

Other Treatment Options

Other treatment options include:

  • Radiofrequency ablation: A minimally invasive procedure that uses heat to target fibroids one by one, reducing their size significantly. Because laparoscopic and ultrasound visualization guides the treatment, even small (less than 1 centimeter) and otherwise hard-to-access intramural leiomyomas can be ablated.
  • Uterine artery embolization (UAE): In this procedure, tiny particles (about the size of grains of sand) are injected into the blood vessels that lead to the uterus. The particles cut off the blood flow to the fibroid and cause it to shrink. UAE can be performed as an outpatient procedure in most cases.
  • Magnetic resonance imaging–guided ultrasound surgery: In this new approach, ultrasound waves are used to destroy fibroids. The waves are directed at the fibroids through the skin with the help of magnetic resonance imaging. Whether this approach provides long-term relief is currently being studied.

Fibroid Treatment Is Not Always Necessary

If you have fibroids but do not have any symptoms, you may not need treatment. Your doctor will check during your regular exams to see if they have grown.

Frequently Asked Questions

What is considered a large intramural fibroid?

Small fibroids can be less than 1 centimeter (cm) to 5 cm, the size of a seed to a cherry. Medium fibroids range from 5 cm to 10 cm, the size of a plum to an orange. A large intramural fibroid can be 10 cm or more, ranging from the size of a grapefruit to a watermelon.

How long should you wait to get pregnant after an intramural fibroid myomectomy?

You’ll need to wait three to six months after your myomectomy to start trying to get pregnant to give your uterus time to heal.

What is a calcified intramural fibroid?

In some cases, fibroids can outgrow their own blood supply and start to degenerate. The degeneration process can lead to thin, eggshell-like calcification in the fibroid. This calcification can be seen on a plain X-ray or pelvic ultrasound, but it has no clinical significance whatsoever. Calcification is seen in approximately 4% of fibroids.

How do you shrink fibroids naturally with herbs?

Drinking green tea could help get rid of fibroids or manage their symptoms. A 2013 study found that the flavanol EGCG, found in green tea, reduced the size of uterine fibroids and improved symptoms of anemia and blood loss. However, the study has a small sample size and more research is needed in this area.

A Word From Verywell

Intramural fibroids are the most common type of uterine fibroid. In some cases, the fibroids are small and don’t cause any symptoms at all. Other times, they can impact your day-to-day life with pain, excessive bleeding, and discomfort.

If you notice any irregular bleeding or other symptoms, schedule a visit with your healthcare provider. Intramural fibroids are treatable, and your doctor will be able to provide you with advice and recommendations for specific treatment options.

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11 Sources
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