Which Type Of Fibroids Cause Heavy Bleeding?

Uterine leiomyoma which is commonly referred to as a fibroid, are benign growths which develop in the myometrium also known as smooth muscle layer of uterus. Aside from smooth muscle, leiomyomas also contain extracellular matrix which are namely proteoglycan, collagen, and fibronectin. Fibroids are also named as fibromyoma, myofibroma, and myoma.

Which Type Of Fibroids Cause Heavy Bleeding?

Which Type Of Fibroids Cause Heavy Bleeding?

There are three types of fibroids that can appear in the uterus, these are intramural, subserosal and submucosal. Submucosal fibroids, which grow just below the uterine membrane and within the endometrial cavity, are the least frequent type of fibroma. However, this type of fibroids usually causes symptoms such as heavy and prolonged menstrual periods.

Leiomyoma is the most common pelvic tumor in women, originating symptoms in approximately 25% of women in reproductive age. With a careful pathologic examination of the uterus, it can be revealed leiomyomas in more than 70% of cases, because leiomyomas may be present, but it is not symptomatic in many patients. The affected uterus has six to seven fibroids on average.

Leiomyomas are classified by their situation in the uterus. Subserosal leiomyomas are placed under the uterine serosa and can be pedunculated (attached to the body of the uterus by a narrow stem) or sessile (broad base). Intramural leiomyomas are generally confined to the myometrium within its thickness but can alter the shape of uterine cavity or change the contour of the external portion of the uterus. Submucous leiomyomas are located beneath the endometrium or the uterine mucosa and similar to subserosal leiomyomas they can be either sessile or pedunculated. Approximately 95% of all leiomyomas have subserosal or intramural locations; submucosal leiomyomas constitute the remaining 5%.

Although doctors use this classification scheme extensively, it is limited due to the fact that some leiomyomas are of “pure” type. Majority of leiomyomas have diverse locations and thus are termed hybrids (for example, chiefly intramural leiomyoma with a submucosal component). Some of the other types of leiomyomas are called “parasitic” myomas as they get their nourishment in the form of blood from body structures other than uterus (for example, the omentum), and the “seed-like” myomas, which have a diameter less than or equal to four millimeters.

What Are Submucosal Myomas?

The endometrium is the deepest layer of the uterus. This mucosal layer expands during each menstrual period with the goal of harboring the embryo that would form in the event that the woman became pregnant. When this does not happen, the endometrium is detached and desquamated producing the bleeding that we know as menstruation leaving only a thin mucosal layer of endometrium that will grow back during the next menstrual cycle.

Submucosal fibroids are those that form under the mucus layer that lies inside of the uterus, called the endometrium, which is preserved in all menstrual cycles. These fibroids grow into the uterus and are the type of myomas that cause the most serious hemorrhagic symptoms in women. In some cases, submucosal fibroids are hanging by a pedicle, similar to pedunculated subserosal myomas, but inwardly, and they can also prolapse outwardly through the aperture that connects the uterus to the vagina.

Symptoms of Submucosal Fibroids: Uterine Bleeding

As it was explained previously, submucosal myomas are the type of myoma that causes the most severe hemorrhagic symptoms compared to the rest of fibroids. Among them, there may be a prolongation in the menstrual cycles of the woman, an increase in the intensity and amount of bleeding, as well as the appearance of these hemorrhages during intermenstrual periods.

Due to this abnormal bleeding, it is common for some patients to suffer from chronic anemia or iron deficiency due to blood loss.

In the same way, infertility is a frequent symptom, which is not mandatory, in women who have the uterine fibroids, whether submucosal or otherwise. This is principally due to the anatomical, content and functional alterations that the uterus suffers because of these benign tumors, preventing the gametes (sperm and ovum), the zygote (fertilized ovum by a sperm) cling to join the walls of the uterus.

Treatment will depend on the size of the submucosal fibroids; the surgeon will choose a determined surgical technique to extract them.

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