Awful Cramping and Heavy Menstruation? Blame Submucosal Fibroids

Uterine fibroids are benign (noncancerous) growths in the uterus that affect 70 percent to 80 percent of women during their reproductive years. Where a fibroid is located can affect the severity of symptoms you experience. Some fibroids cause more health issues than others.

A quick primer on fibroids

There are three main types of fibroids based on their location in the womb, according to Harvard Health:

• Intramural fibroids. These grow in the muscle wall of the uterus.
• Subserosal fibroids. These grow from the uterus into the pelvic cavity.
• Submucosal, or intracavitary, fibroids. These grow into the uterus.

"Intramural fibroids, developing in the wall of your womb, are the most common of all fibroid types," said Samantha Wild, M.R.C.G.P., M.B.Ch.B., a general practitioner and women's health clinical lead for Bupa Health Clinics in the United Kingdom.

Submucosal fibroids, although rare, can cause the most severe symptoms.

Symptoms of submucosal fibroids

One of the most common symptoms of submucosal fibroids is heavy bleeding during your period.

"As the submucosal fibroid is located within the uterine cavity, it expands the surface area of the uterine lining to make more blood available to feed the fibroids," Wild explained. "This means that those with submucosal fibroids experience abnormal bleeding during their periods which may be heavier and longer."

This heavy bleeding can lead to other serious issues, such as anemia. Women with submucosal fibroids are more likely to have lower hemoglobin levels and a higher risk of anemia, suggested a 2013 study published in the American Journal of Obstetrics & Gynecology.

In addition to heavy bleeding and anemia, Mayo Clinic lists several other symptoms you may experience with submucosal fibroids.

Symptoms of submucosal fluids include:

• Heavy bleeding
• Anemia
• Pelvis, lower back or leg pain
• Prolonged periods
• Large blood clots during your period
• Dizziness, fatigue or low energy
• Frequent urination or difficulty urinating
• Constipation

How submucosal fibroids affect fertility

Unfortunately, submucosal fibroids can negatively impact your fertility. Submucosal fibroids could reduce fertility by 70 percent. These fibroids can affect someone's chances of conceiving and are often the reason behind recurring miscarriages.

"Compared with other fibroids, submucosal fibroids interfere most with fertility as they may cause difficulties when trying to conceive," Wild said. "This is because the fibroid grows from the womb muscle wall into the womb cavity. Fibroids can block the fallopian tube, making it more difficult for sperm to reach the egg."

A fertilized egg needs to implant into a well-prepared endometrial lining, added Kiarra King, M.D., an OB-GYN in Melrose Park, Illinois.

"If submucosal fibroids are distorting the endometrial cavity, it can be difficult for a fertilized egg to implant," King said. "Submucosal fibroids can also increase the risk of spontaneous miscarriage."

The location and size of the submucosal fibroid may matter to fertility, suggested a 2021 study in the journal Experimental and Therapeutic Medicine. These factors can affect the shape of the endometrial cavity and the ability of the uterus to contract appropriately, cause inflammation and remodel the blood supply of the uterus—all of which can impair fertility.

Risk factors for developing fibroids

The risk factors associated with uterine fibroids include:

• Age
• Lifestyle
• Race
• Family history

"The prevalence of fibroids, in general, is two to three times higher in Black women compared to white women," King said.

Women between the ages of 30 and 50 are the most likely to get fibroids, Wild added.

"Fibroid risk is higher if you've not had children, too," Wild said. "Lifestyle and weight are believed to influence the likelihood of developing fibroids, with obesity linked to an increased risk due to higher estrogen levels in the body."

Nutrition may also play a role. Women who eat a diet high in red meat and low in green vegetables, fresh fruits and dairy are at a higher risk of developing fibroids. Drinking alcohol is also linked to an elevated risk of developing fibroids.

Treating submucosal fibroids

Depending on the type, size and location of the fibroid, your doctor may recommend medication or one of several surgical options.

"The treatment type best for you will depend on your symptoms, how much these affect your everyday life and whether you want to have children in the future," Wild said. "If your symptoms are mild, you may not need any treatment. But if you have more severe symptoms, you should always see a general practitioner to discuss them."

Medication

If your symptoms are mild, your doctor may recommend over-the-counter medications such as acetaminophen or ibuprofen to help manage your pain.

A healthcare professional may recommend iron supplements if you are suffering from anemia. Always consult your doctor before starting a supplement to ensure you are taking the correct amount for your body. Excess iron can lead to severe organ damage.

Birth control can also help alleviate the pain and heavy bleeding associated with uterine fibroids, and can help prevent fibroid growth. Contraceptives believed to help fibroids include the low-dose birth control pill, the Depo-Provera shot and an intrauterine device (IUD).

Prescription medications, including gonadotropin-releasing hormone agonists (GnRHa), also can help shrink fibroids.

Surgery

The Office of Women's Health, part of the U.S. Department of Health and Human Services, lists several surgery options for fibroids:

• Myomectomy. This surgery removes fibroids without taking healthy tissue and is best for women who want to get pregnant after treatment.
• Hysterectomy. This surgery removes the uterus completely. It is the only surgery that ensures fibroids won't grow back. However, women who get a hysterectomy cannot become pregnant.
• Endometrial ablation. With this surgery, the lining of the uterus is destroyed to alleviate heavy bleeding. Women cannot get pregnant after endometrial ablation.
• Myolysis. This treatment involves inserting a needle into the fibroid and destroying it with either an electric current or freezing.
• Uterine fibroid embolization (UFE) or uterine artery embolization (UAE). With these treatments, a thin tube is threaded into the blood vessels that supply blood to the fibroid. Tiny particles made from plastic or gel are then injected, blocking the blood supply. Without blood, the fibroid shrinks.

"The location of submucosal fibroids in the uterus generally makes them amenable to myomectomy," King said, noting that a hysteroscopy exam uses a small camera to view the uterus. "A small operating port on the device allows instruments to be passed inside the uterus to facilitate the removal of fibroids."

UFE and UAE are considered minimally invasive procedures and are another possible treatment option for submucosal fibroids, Wild added.

The bottom line

If you have been diagnosed with fibroids or believe you may have fibroids, speak to your doctor about the right treatment option for you based on your age, lifestyle, risk factors and future pregnancy plans.

Do you have questions you want answered? Don't keep putting it off. Giddy Telehealth provides convenient access to hundreds of healthcare professionals. Many offer same-day appointments or video consultations.