What Is a Submucosal Fibroid?

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Uterine fibroids, also called leiomyomas, are growths in the uterine wall. The vast majority of uterine fibroids are benign (not cancerous).

Fibroids are fairly common, found in up to 80% of people with uteruses by 50 years of age.

Fibroids often do not cause symptoms, but 20% to 50% of cases are symptomatic and may require treatment.

Submucosal fibroids are a type of uterine fibroid that grow in the uterine cavity, just under the surface of the endometrium (uterine lining).

Submucosal fibroids are the least common type of uterine fibroids, but they typically cause the most problems.

Fibroids can develop as a single nodule (one growth) or in a cluster (a group of growths). Fibroid clusters can vary widely in size. Some are as small as 1 mm (0.04 inches); others are as large as 20 cm (8 inches) in diameter or more. Uterine fibroids can grow to the size of a watermelon.

checking for fibroids

Henadzi Pechan / Getty Images

Symptoms

Submucosal fibroids are associated with heavy menstrual bleeding, causing an estimated 5% to 10% of cases of abnormal uterine bleeding.

Symptoms of submucosal fibroids include:

  • Heavy and prolonged menstrual bleeding between or during periods
  • Anemia, sometimes severe (caused by heavy bleeding)
  • Pain in the pelvis or lower back
  • Passing frequent or large blood clots
  • Fatigue
  • Dizziness

Causes

While it isn't known exactly what causes fibroids, some risk factors have been identified.

Age

Fibroids become more common as people with uteruses age, particularly starting around age 30 and lasting through menopause. Fibroids often shrink after menopause.

A later than typical onset of menopause may increase the risk of fibroids.

The age of first menstruation also plays a role in the risk of fibroids.

Fibroids rarely develop before a person has experienced their first menstrual period.

Those who begin menstruating when they are younger than age 10 appear to have a higher risk of developing fibroids later on. A first menstrual period occurring older than age 16 has been associated with a decreased risk.

Family History

A person with a uterus who has another family member or members who have experienced fibroids are at an increased risk of developing uterine fibroids. The risk is about three times higher than average your parent had fibroids.

Ethnicity

Black people with uteruses are significantly more impacted by fibroids than are white people with uteruses.

Black people are up to three times more likely to get uterine fibroids and are more likely to have more severe symptoms and complications from fibroids.

Standard medical treatment for fibroids affects Black people differently than it does white people, signifying a need for treatment plans to adjust for this.

While the exact cause of this discrepancy is not yet known, health disparities linked to medical racism almost certainly play a large part.

More studies are needed exploring the causes, diagnosis, and treatment of fibroids in Black people with uteruses. Medical protocols for uterine fibroids need to be developed with awareness of these differences to make diagnosis, prevention, and treatment of fibroids in Black people more effective.

Hormones

The sex hormones estrogen and progesterone appear to play a major role in the growth of uterine fibroids.

This theory is supported by evidence such as that artificial hormones (like in the birth control pill) and menopause (when estrogen levels decrease) are associated with the shrinking of fibroids.

Body Size/Shape

People with uteruses who are overweight are at higher risk for fibroids, with those who are very overweight being at a higher risk than those who are less overweight.

Research supports the belief that obesity is associated with a higher likelihood of uterine fibroids, but it is unclear if obesity causes fibroids or if fibroids are just more common in people who are overweight.

The results of a study done in 2014 indicate the presence of uterine fibroids is positively associated with:

  • Current body mass index
  • Waist circumference
  • Hip circumference
  • Waist-to-height ratio
  • Body fat mass
  • Body fat percentage
  • Intracellular water

The participants in the study who showed the highest risk were those with higher:

  • Body mass indices
  • Waist-to-hip ratios
  • Body fat percentages (greater than 30%)

Diet

What people with uteruses eat may affect their risk for fibroids.

An increased incidence of uterine fibroids has been associated with:

  • A diet high in red meats (such as beef and ham)
  • The consumption of alcohol
  • A diet that lacks an adequate amount of fruits and vegetables
  • Vitamin D deficiency
  • Food additives
  • Use of soybean milk

Dairy and citrus fruits appear to decrease the risk of fibroids.

Parity

Parity (the number of children a person has given birth to) may affect the risk of developing fibroids.

The risk of developing fibroids in people who have had multiple births is reduced, while nulliparity (never having given birth) may increase the risk of fibroids.

When Are Fibroids a Medical Emergency?

Seek immediate medical attention if:

  • You have severe vaginal bleeding.
  • You have new or worse belly or pelvic pain.

Diagnosis

A uterine fibroid or fibroid cluster is sometimes discovered during a pelvic exam as part of a routine physical, a gynecological exam, or prenatal care.

To help visualize the size of the fibroid or fibroid cluster, a healthcare provider may use common objects as a comparison.

For instance, the fibroid may be likened to:

  • Types of fruit (blueberry, grape, apple, melon, etc.)
  • Nuts (acorn, walnut, etc.)
  • Sports balls (golf ball, softball, soccer ball, etc.)

Imaging tests and procedures can be performed to give a better view of the fibroids and affected areas.

These might include:

  • Ultrasound
  • Magnetic resonance imaging (MRI)
  • X-rays
  • Cat scan (CT)
  • Hysterosalpingogram (HSG): Injecting dye into the uterus and doing X-rays
  • Sonohysterogram: Injecting water into the uterus and doing an ultrasound

Sometimes a healthcare provider may want to do surgery to make or confirm a diagnosis of fibroids. These surgeries are typically:

  • Laparoscopy: A long, thin scope with a bright light and camera is inserted into a tiny incision in or near the navel (belly button). The uterus and other areas being explored are broadcast to a monitor during the procedure for the healthcare provider to view. Pictures may be also be taken.
  • Hysteroscopy: A long, thin scope with a light (and sometimes a camera) is inserted into the vagina through the cervix and into the uterus. This procedure lets the healthcare provider check inside the uterus without making an incision.

Treatment

The goals of treatment for fibroids include:

  • A reduction in menstrual bleeding
  • Pain relief
  • Relief of cramps and tension
  • Improving problems with other organs affected by the fibroids, such as emptying the bladder or bowel and digestion
  • Preserving or improving fertility

Which treatment is used depends on factors such as:

  • Age
  • General health
  • Type and severity of symptoms
  • Type of fibroids
  • Pregnancy (currently pregnant or may want to be in the future)

Watchful Waiting

Fibroids do not always require treatment. If the fibroids are not causing problems or bothersome symptoms, a "wait and see" approach may be appropriate.

With this plan, the fibroids are monitored for changes and growth through regular pelvic exams and/or ultrasounds.

Hysterectomy

Hysterectomy is a surgery to remove the uterus. It may or may not also involve the removal or one or both ovaries and/or fallopian tubes. If the ovaries are removed with the uterus, menopause will begin immediately.

Types of hysterectomies include:

  • Total hysterectomy: Removal of uterus and cervix
  • Subtotal (also called supracervical) hysterectomy: Removal of the uterus but not the cervix

A hysterectomy completely eliminates the fibroids and the symptoms that come with them. It also guarantees the fibroids won't return.

That said, a hysterectomy can have a number of disadvantages, such as:

  • It is a major surgery that requires anesthesia and may have surgery-related complications.
  • It has a recovery period of two to six weeks, depending on the type of hysterectomy.
  • There is an increased risk of urinary incontinence.
  • People who have had hysterectomies reach menopause an average of two years earlier than those who have not had a hysterectomy.
  • It ends menstruation.
  • It makes childbearing impossible, ending fertility.
  • It can have negative psychological impacts.

The National Institute for Health and Care Excellence (NICE) recommends that hysterectomy should be considered only when:

  • Other treatments are not an option or have not worked.
  • The person with fibroids wants to end menstruation.
  • The person with fibroids requests it after being fully informed about the procedure and the risks involved.

Myomectomy

During a myomectomy surgery, uterine fibroids are removed but the uterus is left intact.

The three main types of myomectomy are:

  • Open myomectomy: Usually used for very large fibroids, the fibroids are removed through an incision in the abdomen that may go up and down or across like a bikini cut.
  • Minimally invasive laparoscopic myomectomy: This involves several small incisions (standard laparoscopic myomectomy) or one slightly larger incision (single port myomectomy).
  • Hysteroscopic myomectomy: The fibroids are removed through the vagina with no incisions, using a camera.

A myomectomy usually allows the uterus to return to normal functioning, with periods remaining or returning.

A myomectomy also makes future pregnancies possible, but the pregnancy may need to be monitored for possible risks and a cesarean section may be needed, depending on how deep the fibroids were and if any spanned a large part of the uterine wall.

Recovery can take up to six weeks.

Unlike with a hysterectomy, fibroids can return after a myomectomy, with a recurrence rate of 15% to 30% at five years, depending on the size and extent of the fibroids.

A myomectomy may have surgery-related complications including bleeding and infection.

A Warning About Laparoscopic Power Morcellation

Laparoscopic power morcellation is a procedure that uses a medical device to break uterine fibroids into small pieces, allowing them to be removed through a small incision in the abdomen.

The Food and Drug Administration (FDA) has issued a warning about this procedure, because if the person also has uterine cancer, this procedure may cause the cancer to spread within the abdomen and pelvis. This can make the cancer harder to treat.

Uterine Fibroid Embolization (UFE)

UFE is a procedure for treating fibroids in which a thin catheter is inserted into the artery at the groin or wrist through a small incision and guided to the fibroid's blood supply.

Small particles (about the size of grains of sand) are released and float downstream to block the small blood vessels, depriving the fibroid of nutrients. 

This causes the fibroid to soften, bleed less, and shrink in size. About 90% of people who have UFE report significant improvement in their symptoms, or the symptoms go away completely.

Some advantages of UFE are:

  • It does not require general anesthesia.
  • There is no abdominal incision.
  • There is minimal blood loss.
  • All fibroids can be treated at the same time.
  • It does not cause low bone density or the other serious side effects associated with some hormonal therapies.

Some disadvantages of UFE are:

  • It is as expensive as a hysterectomy.
  • It is not recommended for people who hope to become pregnant due to its unpredictable effect on fertility.
  • There's a possibility of delayed infection sometime in the first year, which can become life-threatening if not treated.
  • It is not a guaranteed cure; fibroids can return.
  • Some insurance plans may not cover it.

Endometrial Ablation

Endometrial ablation is a procedure that uses heat to destroy the endometrium (the lining of the uterus).

It is usually performed to stop heavy menstrual bleeding, but it can also be used to treat small fibroids. It is not effective for large fibroids or for fibroids that have grown outside of the interior uterine lining.

It is usually done on an outpatient basis and is a quick procedure, taking as few as 10 minutes to complete. While recovery typically takes a few days, watery or bloody discharge can last for several weeks.

This procedure usually stops monthly menstruation. When the flow is not stopped completely, it is usually significantly reduced.

Endometrial ablation is not recommended for people who wish to become pregnant.

The procedure reduces the chances of pregnancy but does not eliminate the possibility. Because the procedure increases the risks of complications, including miscarriage and ectopic (tubal) pregnancies, people who have endometrial ablation must take steps to prevent pregnancy.

Endometrial ablation may delay or make it more difficult to diagnose uterine cancer in the future, as postmenopausal bleeding or irregular vaginal bleeding can be warning signs of uterine cancer.

People who have endometrial ablation should continue to have recommended pap smears and pelvic exams to monitor their uterus and cervix.

Ultrasound Guided Radiofrequency Ablation

With this minimally invasive procedure, high energy waves are used to generate heat that destroys fibroids.

Using ultrasound, the healthcare provider verifies the correct placement of the radiofrequency device within each fibroid before ablation is performed.

The procedure is usually performed on an outpatient basis and is considered relatively low risk.

Magnetic Resonance Guided Focused Ultrasound (MRgFUS)

MRgFUS is a non-invasive procedure that takes about three hours to complete. It is a relatively new treatment for fibroids.

While the person with fibroids lays in a magnetic resonance imaging (MRI) machine, a radiologist identifies and targets the fibroids.

High-intensity ultrasound waves are then used to heat and destroy the uterine fibroids while the person remains in the MRI machine. The procedure uses a device called the ExAblate, which combines MRI with ultrasound.

Although MRgFUS has a low risk of complications and a short recovery time, it does have some limitations, including:

  • There is a lack of long-term studies due to the newness of the procedure.
  • There are few studies on the effects the procedure has on fertility and pregnancy.
  • It cannot treat all types of fibroids.
  • It cannot treat fibroids that are located near the bowel and bladder or are outside of the imaging area.
  • It requires an extensive period of time involving MRI equipment.
  • It is not covered by all insurance companies (many consider this procedure investigational, experimental, and unproven).

Medications

While medications don't cure fibroids, they can help manage fibroids and the symptoms that come with them.

Hormone Therapy

Some medications typically prescribed for birth control can be used to help control symptoms of fibroids. They do not cause fibroids to grow and can help control heavy bleeding.

These medications include:

  • Low-dose birth control pills
  • Progesterone-like injections (e.g., Depo-Provera)
  • An IUD (intrauterine device) called Mirena

Another type of medication used to treat fibroids are gonadotropin-releasing hormone agonists (GnRHa), most commonly a drug called Lupron.

These medications can be administered by injection or nasal spray, or they can be implanted.

GnRHa can shrink fibroids and are sometimes used before surgery to make fibroids easier to remove.

While most people tolerate GnRHa well, side effects can include:

  • Hot flashes
  • Depression
  • Sleep difficulties
  • Decreased sex drive
  • Joint pain

Most people with uteruses do not menstruate when taking GnRHa. This can help those with anemia from heavy bleeding recover to a normal blood count.

Because GnRHa can cause bone thinning, they are generally limited to six months or less of use.

The reprieve offered by GnRHa is considered temporary. The fibroids often grow back quickly once the medication is stopped.

Cost is a consideration when choosing this treatment. These drugs are quite expensive, and insurance companies may not cover all or any of the cost.

Oriahnn: A New Medication

In May 2020, the FDA approved a medication called Oriahnn for the treatment of heavy menstrual bleeding in premenopausal people with uterine fibroids.

The capsule contains elagolix, estradiol, and norethindrone acetate.

Other medications used to treat fibroids include:

  • Tranexamic acid (TXA): It helps boost the blood’s ability to clot, which helps decrease the amount of vaginal bleeding. It's usually used in severe circumstances, such as heavy bleeding, and is generally not used long term. It does not shrink fibroids or help with pain, but can prevent excessive bleeding and anemia.
  • Over-the-counter pain medications: Ibuprofen (Motrin, Advil), acetaminophen (Tylenol), or naproxen (Aleve) do not shrink fibroids, but they can relieve cramping and pain caused by fibroids. These should not be used at high doses for prolonged periods of time.
  • Iron supplements: These can help prevent or treat anemia caused by heavy bleeding.

Prognosis

Submucosal fibroids often cause more bleeding problems than other types of fibroids because they can crowd the uterine space. Even very small submucosal fibroids may cause symptoms.

Submucosal fibroids are also the most likely type of fibroid to lead to pregnancy and fertility problems, including:

  • Cesarean section delivery
  • Breech presentation (baby enters the birth canal upside down with feet or buttocks emerging first)
  • Preterm birth or miscarriage
  • Placenta previa (placenta covering the cervix)
  • Postpartum hemorrhage (excessive bleeding after giving birth)

Other complications of fibroids can include:

  • Severe pain or very heavy bleeding (may require emergency surgery)
  • Twisting of the fibroid (may require surgery)
  • Anemia (low red blood cell count)
  • Urinary tract infections
  • Infertility (in rare cases)
  • Kidney damage (in rare cases)

Coping

If you have symptomatic fibroids, speak with your healthcare provider about treatment plans as symptom management may not be enough.

To help cope with fibroid symptoms while waiting for treatment, you can:

  • Place a hot water bottle on your abdomen.
  • Use a heating pad set to low (protect your skin by putting a thin cloth between the heating pad and your skin, and never go to sleep with a heating pad turned on).
  • Take a warm bath.
  • Lie down and put a pillow under your knees.
  • Lie on your side and bring your knees up to your chest.
  • Use stress management and relaxation techniques such as yoga and meditation.
  • Get at least 2.5 hours of exercise a week, to the best of your ability.
  • Keep track of how many sanitary pads or tampons you use each day.
  • Take a daily multivitamin with iron if you are experiencing heavy or prolonged menstrual bleeding.

More Information on Fibroids

If you have uterine fibroids and are looking for guidance and support, The White Dress Project—a nonprofit organization that is primarily made up of women with impactful fibroid journeys—is a great place to turn to. Other helpful resources include:

Frequently Asked Questions

How do you shrink fibroids naturally with herbs?

Like any type of medication, always consult with a healthcare provider before using herbs or supplements.

Gui Zhi Fu Ling Tang (a combination of herbs) is the most common traditional Chinese medicine used for treating menstrual cramps and fibroids. It can be used by itself or with a standard treatment for fibroids.

Drinking green tea could be helpful in relieving fibroid symptoms. A 2013 study suggests that the flavanol EGCG, found in green tea, may reduce the size of uterine fibroids and improve symptoms of anemia and blood loss.

How fast do fibroids grow?

The growth of fibroids can vary and be difficult to predict.

One study indicated that average fibroid growth is 89% per 18 months. This means a 2 cm fibroid (about the size of a blueberry) is likely to take about four to five years to double its diameter.

The study also found that very small fibroids tend to grow more quickly than larger ones.

Why do fibroids cause heavy bleeding?

The pressure of the fibroid(s) against the uterine wall can cause the endometrial tissue whose lining is shed during menstruation to bleed more than usual.

Another factor may be that fibroids don’t allow the uterus to contract well enough to effectively stop menstrual bleeding.

Fibroids also produce growth factors (proteins) that stimulate the blood vessels of the uterus. This causes more blood in the uterine cavity, leading to heavier periods.

How do you deal with fibroids during pregnancy?

The hormones released during pregnancy to support the growth of the baby can also cause fibroids to get bigger.

Large fibroids can increase the risk of a breech birth by preventing the baby from being able to move into the correct fetal position.

Although rare, there may be a higher risk of complications such as preterm delivery or a cesarean section.

If fibroids are discovered before or during pregnancy, the healthcare provider will monitor them for changes and complications.

A Word From Verywell

While submucosal fibroids are the least common type of uterine fibroids, they can cause serious and unpleasant symptoms such as excessive menstrual bleeding.

If you are experiencing symptoms of fibroids, make an appointment to see your healthcare provider, especially if you are or plan to become pregnant.

Several treatments exist for submucosal fibroids that can get rid of fibroids for good or help manage the symptoms they cause.

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