What are Intramural Fibroids?
Intramural fibroids are one of the most common types of uterine fibroids, found in 70% of women of childbearing age. Unlike subserosal fibroids, which develop on the outside covering of the uterus, and submucosal fibroids, which develop just under the lining of the uterine cavity, intramural fibroids develop within the wall of the uterus.

Intramural fibroids begin as small nodules in the muscular wall of the uterus. With time, intramural fibroids may expand inwards, causing distortion and elongation of the uterine cavity. Sometimes these fibroid tumors may grow towards the endometrial cavity to become submucosal fibroids or they may even grow towards the outer surface of the uterus to become subserosal fibroids.

Symptoms of Intramural Fibroids
Intramural fibroids are generally asymptomatic, but in some women, they may cause problems such as:

• Heavier menstrual bleeding
• Pelvic pain
• Pain in back and the back of the legs
• Constipation and bloating
• Constant urge to urinate
• Lower-abdominal pressure or heaviness due to the weight of large intramural fibroids
• Abnormally large abdomen
• Pain or discomfort during intercourse, if the fibroids are located in the cervix area
• In some extreme cases, intramural fibroids may result in uterine hemorrhage

Intramural Fibroids and Infertility
Normally, intramural fibroids have no effect on fertility and pregnancy. However, in about 3% of women, these uterine fibroids are linked with infertility. Women who have multiple intramural fibroids or very large fibroids may find conceiving troublesome.

Intramural fibroids can prevent sperm from entering the uterine cavity, particularly when the fibroids are located at the cervix. These fibroids can also enlarge the uterine cavity, thereby increasing the distance that sperm need to travel to reach the fallopian tubes. Additionally, intramural fibroids may affect the uterus’s ability to contract, which has a direct impact upon sperm migration and ovum transport.

Implantation of the embryo can also be inhibited by intramural fibroids as they distort the uterine cavity, impairing the blood supply to the endometrium and disturbing the endometrium structure. Even if implantation has occurred successfully, intramural fibroids may interfere with the development of the foetus.

Uterine fibroids usually enlarge as the pregnancy proceeds. Due to this, there is a tussle for space between the growing baby and the intramural fibroids. This struggle may either induce developmental defects in the unborn child or may cause a miscarriage.

Treatment of Intramural Fibroids
If intramural fibroids aren’t interfering with a woman’s ability to get pregnant and aren’t causing any pain, it is likely they will be left untouched. However, if the intramural fibroids are large, treatment might be necessary to reduce the symptoms produced by them.

These uterine fibroids are generally treated by means of three types of surgical procedures:

1. Removal of one or more intramural fibroids by open abdominal surgery called abdominal myomectomy.
2. Destruction of the fibroids through uterine artery embolization in which polyvinyl alchol beads are injected into the uterine artery with a catheter to block the flow of blood to the intramural fibroids
3. Hysterectomy which looks to remove the uterus

At the present time, effective medicines that can permanently shrink these fibroids are not available. Hence, surgical removal is one option available for the treatment of intramural fibroids. There is however a new non-surgical solution that has allowed thousands of women worldwide to successfully eliminate their fibroids pain and other related symptoms within 12 hours and their intramural fibroids permanently within 2 months.

What are Submucosal Fibroids?
The fibroids that develop in the submucosal layer, that is, the inner side of the uterus are called submucosal or subendometrial fibroids. These uterine fibroids usually originate as intramural fibroids, meaning between the muscles of the uterus, and gradually grow towards the endometrial cavity. Sometimes submucosal fibroids may be attached to the uterus by means of a long stalk. Such fibroids tumors are called pedunculated submucosal fibroids.

These stalked fibroids may appear to be similar to pedunculated subserosal fibroids due to the presence of the stalk, but the similarity ends at this point. While submucosal fibroids are confined to the inner layer of the uterus and the endometrial cavity, subserosal fibroids are found only on the outer surface of the uterus.

Another point of difference between submucosal fibroids and the other two types of fibroids is the prevalence. Whilst intramural and subserosal fibroids are common, found in 70 percent and 20 percent of women of reproductive age respectively, submucosal fibroids are rare, accounting for only 5 percent of all occurrences of fibroids among women.

What are the Symptoms of Submucosal Fibroids?
Most women don’t even know that they have uterine fibroids. However, in some women, the presence of submucosal fibroids is quite symptomatic, particularly those who have either multiple or large subendometrial fibroids. Some typical symptoms are:

• Unusually heavy or prolonged menstrual periods
• Severe abdominal cramps during menstrual periods
• Bleeding between menstrual periods
• Postmenopausal bleeding
• Pelvic pain
• Back pain
• Large submucosal fibroids can cause some discomfort in the lower abdomen
• Severe pain, if the stalk of the pedunculate submucosal fibroid twists or if the uterine fibroid outgrows its blood supplies

Can Submucosal Fibroids Cause Infertility?
Submucosal fibroids are known to cause infertility in women of childbearing age. There are several ways in which submucosal fibroids can induce infertility. For instance, they can block the fallopian tube, thus preventing sperm from fertilizing the egg. Large submucosal uterine fibroids may increase the size of the uterus’s cavity. An enlarged cavity increases the distance that sperm have to travel.

These fibroids may have a severe impact on the uterus’s ability to contract, which in turn can interfere with sperm migration and ovum transport. Multiple and large submucosal fibroid tumors can distort the uterus’s cavity, impair the blood supply to the endometrium and disturb the structure of the endometrium through thinning, ulceration, hyperplasia, inflammation or atrophy. In a nutshell, the entire anatomy of the uterus is disturbed and, even if the sperm is able to fertilize an egg, the chances of implantation are drastically reduced.

The presence of submucosal fibroids during pregnancy can lead to pregnancy complications. During the course of pregnancy, these fibroids will also grow in size, thereby decreasing the amount of space available for the baby to grow. As a result, either miscarriage or foetal congenital deformities can occur. Furthermore, submucosal fibroids can increase the chances of postpartum hemorrhage, obstructed labour, stalled labour and cesarean section.

Can Submucosal Fibroids be Treated?
There is no drug treatment that can cure submucosal fibroids permanently. Medicine can provide only temporary relief to the symptoms. Surgical treatment is still considered the best option with respect to submucosal fibroids. Hysteroscopy and submucus resection, which is performed through the vagina, is found to be quite effective for the treatment of symptomatic submucosal fibroids. Laparoscopic method and myolysis is useful for treating pedunculated submucosal fibroids.

Uterine artery embolization is another method used for the treatment of symptomatic fibroids. Another popular method for the treatment of submucosal fibroids is hysterectomy, that is, the removal of the uterus with or without the removal of the cervix. Doctors opt for this method only if the fibroids cannot be managed by other means and the patient does not want further children.

There is however a new non-surgical solution that has allowed thousands of women worldwide to successfully eliminate their fibroids pain and other related symptoms within 12 hours and their submucosal fibroids permanently within 2 months!

What are Subserosal Fibroids?
Subserosal uterine fibroids develop on the outer surface of the uterus and continue to grow outwards, giving the uterus a knobby appearance. At times, these fibroids tumors may be connected to the uterus by the means of a long stalk or a stem-like base. Such stalked fibroids are called pedunculated subserosal fibroids. These fibroids are often difficult to distinguish from an ovarian mass.

Over time, subserosal uterine fibroids may grow quite large but, unlike submucosal fibroids, which can greatly disrupt the shape of the uterine cavity as they develop beneath the uterine lining, these fibroids do not typically affect the size of the uterus’s cavity. Like intramural fibroids, which grow inside the wall of the uterus, subserosal fibroids are also quite prevalent among women in their prime reproductive age.

What are the Symptoms of Subserosal Fibroids?
In the majority of women, subserosal fibroids produce no symptoms. Problems are customarily caused by large and pedunculated subserosal fibroids tumors. Some of the typical symptoms experienced by women with subserosal fibroids include:

• Pelvic pain
• Back pain
• Constipation and bloating
• A generalized feeling of heaviness or pressure
• Frequent urination
• Kidney damage due to compression of the ureter
• Abdominal cramping and pain
• At times, pedunculated subserosal fibroids can twist and cause pain

As subserosal fibroids are located on the outer surface of the uterus, they typically do not affect a woman’s menstrual flow.

Can Subserosal Fibroids Cause Infertility?
Generally, it is believed that subserosal fibroids do not cause infertility. However, in reality, a large and pedunculated subserosal fibroid may have a severe impact on fertility and pregnancy. As these fibroid tumors are located on the outer surface of the uterus, when they grow in size, they start exerting pressure on the surrounding organs and in some extreme case they may even obtain their blood supply from these organs.

Sometimes, enlarged subserosal fibroids may compress the fallopian tubes. In these instances, infertility can occur due to the blockage of the fallopian tube, thereby preventing sperm and egg from meeting. Often, large subserosal fibroids may distort the pelvic anatomy to such an extent that it becomes difficult for the fallopian tube to collect an egg at the time of ovulation. Here again the end result is infertility.

Subserosal fibroids may also interfere with a pregnancy. During the course of pregnancy, these uterine tumors grow with the uterus and the baby. As a result, your uterus becomes cramped and crowded, affecting not only the development of the foetus, but also contributing to pregnancy complications and difficulties in labour.

Is There any Treatment for Subserosal Fibroids?
Unfortunately, medicinal treatment for subserosal fibroids does not exist. Medical therapy is attempted only to alleviate symptoms caused by these uterine fibroids, and all these medical treatments are temporary in nature.

Surgical treatment is most effective in the case of subserosal fibroids. Due to their placement on the surface of the uterus, laproscopy is considered to be the most practical technique for their removal. In laparoscopic myomectomy, the laparoscope is placed in the abdomen through the belly button. This instrument plucks the pedunculated subserosal fibroids, cuts them into small pieces and finally removes them.

Laparoscopy can also be used for myolysis in which subserosal fibroid tumors are not removed but destroyed by blocking their blood supply. Uterine artery embolization is another method for the treatment of subserosal fibroids. Like myolysis, this procedure looks to treat uterine fibroids by cutting off their blood supply.

There is however a new non-surgical solution that has allowed thousands of women worldwide to successfully eliminate their fibroids pain and other related symptoms within 12 hours and their subserosal fibroids permanently within 2 months!