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Submucosal fibroids: characteristics and treatment

One in five women can develop fibroids during their fertile life, but only a small group presents symptoms; if there are submucosal fibroids, these may be more frequent and severe.

Submucosal Fibroids

The Fibroids are benign tumors that grow in the uterus, they can be microscopic or large in size, these can be located under the external surface of the uterus (subserosal), in the thickness of the wall (intramural) or under the surface that lines the inside of the cavity ( submucosal), although they can also be seen attached to a peduncle both in the cavity, being submucosal as well, and on the external part of the organ.

Risks of Submucous Fibroids

Fibroids in general are benignbut the submucosal variety It is the one that is related to the most symptoms. Submucous fibroids of any size can be related to heavy bleeding during menstruation, which is a frequent cause of anemia; The presence of dysmenorrhea, which refers to a lot of pain during labor, is also common. menstrual bleeding.

Another important risk is that the presence of this condition increases the possibility of early pregnancy loss.

How are submucosal fibroids diagnosed?

They can be located with a conventional ultrasound, but many times this does not allow differentiation between fibroids that are intramural (in the wall of the uterus) and submucosal ones (in the cavity), which is why it is required 3D ultrasound or one Hysterosonography; It can also be done with a pelvic MRI, although with very small fibroids it has its limitations.


The treatment has two components, one is the management of symptoms and potential anemia, which can be done with anti-inflammatories, oral contraceptives, progestins, and antifibrinolytics such as tranexamic acid that seek to reduce the associated pain and bleeding.

The second component is the fibroid dissolution which implies the need for surgical treatment, either a Myomectomy What is fibroid removal or a Hysterectomyremoval of the uterus.

Depending on the size, location and number of fibroids, the decision on the type of surgery is made. These may be:

  • Hysteroscopy: vaginal route
  • Laparoscopy: abdominal route

Sometimes the decision is to remove only the fibroids or, in some cases, a hysterectomy is chosen due to the patient’s preference to avoid recurrences or because there are other associated risks and a more radical management is chosen.

What happens if treatment is not done?

When there are not many symptoms or it responds favorably to the medical treatments prescribed and the person does not have a pregnancy planned, one can be expectant without going to surgery, always taking two things into account:

  • The first, some of the medications used to control bleeding, when used for a long time, can increase the risk of Thromboembolism.
  • The second, it may happen that a small fibroid that can be easily removed by hysteroscopy and which it is decided not to operate on, over time increases in size and requires a more extensive or invasive procedure.

Whenever there is a finding of this type of fibroids or in the presence of abundant bleeding or pregnancy losses without a clear diagnosismust be consult a specialist to evaluate the possibility of this type of fibroids, which are sometimes very small, difficult to identify, but capable of generating a lot of symptoms and, frequently, can be solved with a quick and safe procedure.