Is the location of my fibroid important?

One of the most important factors to consider when diagnosing and treating fibroids is their location; the position of a fibroid within the uterus can affect the symptoms it causes, the treatment options available, and even the risk of complications during pregnancy.

This article explores the importance of fibroid location and how it impacts symptoms, fertility, pregnancy, and treatment options.

What are the most common locations where fibroids can develop?

Fibroids can develop in several different areas within or around the uterus:

• Submucosal fibroids: These fibroids grow beneath the lining of the uterus. They protrude into the uterine cavity and can affect the uterus' ability to shed its lining properly.
• Intramural fibroids: These fibroids develop within the uterine muscle wall. They are the most common type and can often go unnoticed unless they grow large enough to cause symptoms.
• Subserosal fibroids: These fibroids form on the outer surface of the uterus, pressing outward towards the abdominal cavity. They can become quite large without affecting the inside of the uterus.

How does the location of a fibroid influence its symptoms?

The symptoms caused by fibroids can vary greatly depending on their location. While some fibroids may remain asymptomatic, others can lead to significant health issues.

Submucosal fibroids, for example, are more likely to cause heavy or prolonged menstrual bleeding. They can also lead to painful periods and may cause a feeling of fullness or pressure in the pelvic area.

Similarly, intramural fibroids can also cause changes in menstrual patterns, such as longer or more painful periods. Additionally, they may lead to back pain, bloating, or constipation, especially if they grow large enough or they press on nearby organs.

Subserosal fibroids are less likely to cause significant bleeding or affect menstruation. However, they may lead to a sensation of fullness or bloating in the abdomen, and large subserosal fibroids may also cause pain or discomfort if they press against surrounding organs.

Can fibroids in certain locations impact fertility / pregnancy?

Yes, fibroids in certain locations can have a significant impact on fertility and pregnancy.

Submucosal fibroids are the most likely to interfere with fertility due to their position. These fibroids can alter the shape of the uterine cavity, making it harder for a fertilised egg to implant. For pregnant women, they can also increase the risk of miscarriage or early pregnancy loss.

Intramural fibroids can equally impact fertility, especially if they are large or located in certain areas. They can change the shape of the uterus, disrupt the normal contractions of the uterine muscles, and affect the ability of sperm to reach the egg.

While subserosal fibroids are less likely to directly affect fertility, they can still cause complications. If large enough, they can cause mechanical problems, compressing the fallopian tubes or impacting blood flow to the uterus and making conception more challenging.

If you’re planning a pregnancy, or have fibroids and are concerned about fertility, it’s important to consult with your gynaecologist to discuss your options.

Is the location of my fibroid important for treatment?

The location of a fibroid is a key factor in determining the best treatment approach. For example, submucosal fibroids are more likely to require treatment due to their impact on menstruation and fertility. These fibroids can often be treated with a hysteroscopic myomectomy, which removes the fibroid through the cervix.

Intramural fibroids can be managed with medications to alleviate symptoms, or a myomectomy, which removes the fibroid either through an abdominal incision or using laparoscopy. For women who prefer to avoid surgery, uterine artery embolisation can be an option to shrink the fibroid.

Subserosal fibroids usually don't require treatment unless they cause significant symptoms like pain or pressure. If treatment is necessary, options include medications, uterine artery embolisation, or laparoscopic or robotic surgery to remove the fibroid.

Depending on hormonal changes, fibroids may also naturally shrink or shift position within the uterus, while others may grow larger. Regular monitoring is essential to track the fibroid’s growth and determine if additional treatment is needed.