Intramural Fibroids Treatment in Delhi, India

Intramural fibroids are non-cancerous growths that form within the muscular wall (myometrium) of the uterus. These fibroids are one of the most common types of uterine fibroids and can vary in size, from being microscopic to significantly large, sometimes altering the shape of the uterus. While they are typically harmless, larger fibroids can lead to symptoms such as heavy menstrual bleeding, pelvic pain, and fertility challenges. Their growth is influenced by hormones like estrogen and progesterone, and they often require medical evaluation to determine the best management approach.

Intramural fibroids can be categorised based on various factors such as size, location, and impact. However, the most common classification is based on their location within the uterus.

Anterior Intramural Fibroid

This type is located in the front wall of the uterus. It often exerts pressure on the bladder, leading to symptoms such as frequent urination or a feeling of incomplete bladder emptying. The location makes it more likely to affect urinary functions.

Posterior Intramural Fibroid

Located in the back wall of the uterus, this type can press on the rectum, resulting in symptoms like constipation, rectal discomfort, or lower back pain. Depending on its size, it can also impact nearby pelvic structures.

Fundal Intramural Fibroid

Situated in the upper part of the uterus (the fundus), this type can interfere with uterine contractions, leading to heavy menstrual bleeding. It may also pose challenges during pregnancy, especially if it alters the shape of the uterine cavity.

The exact cause of intramural fibroids is not fully understood, but several factors are thought to contribute to their development. These include hormonal, genetic, and environmental factors.

• Hormonal Influence: Estrogen and progesterone are key hormones that stimulate the growth of the uterine lining. Fibroids respond to these hormones, growing larger during reproductive years and shrinking after menopause.
• Genetics: A family history of fibroids can increase the likelihood of developing them, suggesting a hereditary component.
• Obesity: Being overweight increases estrogen levels in the body, which can contribute to fibroid development.
• Lifestyle Factors: Poor diet and lack of exercise may also play a role in the formation of fibroids.
• Early Menstruation: Women who start menstruating at a younger age are at a higher risk of developing fibroids.
• High Blood Pressure: Women with hypertension may have an increased risk of developing fibroids.

Certain factors increase the likelihood of developing intramural fibroids. Understanding these risk factors can help in identifying those who may be more susceptible.

• Family History: Having close relatives with fibroids increases the risk of developing them.
• Age: Fibroids are more common in women between the ages of 30 and 40, especially those who have not reached menopause.
• Hormonal Imbalance: Prolonged exposure to estrogen and progesterone, particularly in women who have not had children, is a significant risk factor.
• Obesity: Higher body weight leads to increased estrogen levels, which can stimulate fibroid growth.
• Diet: A diet high in red meat and low in green vegetables has been associated with an increased risk of fibroids.
• Ethnicity: African-American women are more likely to develop fibroids at a younger age and may experience more severe symptoms.
• Medical Conditions: Conditions like high blood pressure or diabetes may increase the risk of fibroids.

Intramural fibroids may not always cause symptoms, especially if they are small. However, larger fibroids or those that press on surrounding organs can lead to various discomforts.

• Heavy Menstrual Bleeding: One of the most common symptoms, which can lead to anaemia if left untreated.
• Pelvic Pain or Pressure: The size or position of the fibroid may cause discomfort or a feeling of fullness in the lower abdomen.
• Frequent Urination: Fibroids pressing against the bladder can result in the frequent need to urinate or a feeling of incomplete bladder emptying.
• Painful Intercourse: Fibroids located in certain areas of the uterus can make sexual activity uncomfortable.
• Lower Back Pain: Large fibroids can press on the back, leading to persistent discomfort or pain.
• Infertility or Miscarriage: In some cases, intramural fibroids may affect fertility or lead to complications in pregnancy, though this is not always the case.

Diagnosing intramural fibroids typically involves a combination of physical exams, imaging tests, and sometimes lab work to confirm the presence and assess the size and location of the fibroids.

• Pelvic Exam: A healthcare provider may detect a mass or enlarged uterus during a routine pelvic examination.
• Ultrasound: The most common imaging technique used to visualize the fibroids and determine their size and location.
• MRI: A more detailed imaging test that can be used if the ultrasound results are inconclusive or to plan treatment options.
• Hysteroscopy: In some cases, a small camera may be inserted into the uterus to examine the interior for fibroids, particularly if they are near the uterine lining.
• Sonohysterogram: A special ultrasound procedure where a saline solution is injected into the uterus to better outline the fibroids.
• Laparoscopy: In rare cases, a surgical procedure may be performed to examine the uterus directly if other diagnostic methods are inconclusive.

Treatment for intramural fibroids depends on factors such as the size and location of the fibroids, the severity of symptoms, and the patient’s overall health and reproductive plans.

• Medications: Hormonal treatments like birth control pills, IUDs, or GnRH agonists can help manage symptoms by regulating hormone levels and reducing fibroid growth. These treatments may be used to control heavy bleeding and pelvic pain.
• Uterine Artery Embolization (UAE): A minimally invasive procedure where the blood supply to the fibroid is blocked, causing it to shrink. This option is suitable for women who want to avoid surgery.
• Myomectomy: Surgical removal of the fibroids while preserving the uterus. This is typically recommended for women who wish to retain their fertility.
• Hysterectomy: The complete removal of the uterus, which is often considered for women who no longer wish to have children or when other treatments have not been successful.
• MRI-guided Focused Ultrasound (FUS): A non-invasive procedure that uses high-frequency ultrasound waves to target and destroy fibroids by heating them. It is typically used for women who wish to avoid surgery and have fibroids that are easy to access.
• Endometrial Ablation: A procedure that involves destroying the lining of the uterus to reduce bleeding. This is typically recommended for women who have completed their family planning.

Though many women with intramural fibroids experience few or no complications, some may face issues that can impact their health and quality of life.

• Infertility: Large or multiple fibroids can distort the shape of the uterus and block the fallopian tubes, making it more difficult for a woman to conceive.
• Pregnancy Complications: Fibroids may increase the risk of miscarriage, premature birth, or complications during labour, particularly if they are located near the uterine cavity.
• Heavy Menstrual Bleeding: Severe bleeding can lead to anaemia, which may cause fatigue, weakness, and other health problems if not properly managed.
• Urinary and Bowel Issues: Large fibroids pressing against the bladder or rectum can cause urinary retention, constipation, or back pain.
• Painful Sex: Fibroids can make sexual intercourse painful, particularly when they are located in certain parts of the uterus.
• Psychological Effects: Chronic symptoms such as pain, heavy bleeding, and fertility issues can affect a woman’s emotional well-being and quality of life.

While it may not be possible to completely prevent intramural fibroids, there are several strategies that may help reduce the risk of developing them or manage their symptoms effectively.

• Maintain a Healthy Weight: Being overweight can increase estrogen levels, which may contribute to fibroid growth. Maintaining a healthy weight through regular exercise and a balanced diet may help reduce the risk.
• Eat a Balanced Diet: Consuming a diet rich in fruits, vegetables, and whole grains while limiting red meat intake may help lower the risk of fibroids. A diet high in antioxidants may also have a protective effect.
• Regular Exercise: Physical activity can help maintain a healthy weight, balance hormones, and improve overall well-being, potentially lowering the risk of fibroid development.
• Control Hormonal Imbalances: Hormonal therapies, such as birth control pills or IUDs, may help regulate hormone levels and reduce the risk of fibroids. Consult with a healthcare provider to find the most appropriate option.
• Limit Alcohol and Caffeine: Excessive alcohol and caffeine intake has been linked to hormonal imbalances, which can contribute to fibroid growth. Limiting these substances may be beneficial.
• Monitor Blood Pressure: Managing high blood pressure through lifestyle changes or medication can help reduce the risk of developing fibroids.
• Regular Health Checkups: Early detection of fibroids through routine pelvic exams and imaging tests may help catch them early and allow for timely intervention if necessary.

Can Intramural Fibroids Affect My Fertility?

Yes, large or multiple fibroids can distort the shape of the uterus and block the fallopian tubes, which can make it harder to conceive. However, many women with fibroids still have successful pregnancies.

Can Intramural Fibroids Lead to Miscarriage?

In some cases, fibroids can increase the risk of miscarriage, especially if they are large or located in areas of the uterus where the pregnancy would implant. However, many women with fibroids have healthy pregnancies.

Are Intramural Fibroids Cancerous?

No, intramural fibroids are typically benign (non-cancerous) tumors. However, it is important to have regular checkups to monitor the fibroids and ensure they are not causing complications.

How Can I Manage the Pain Caused by Intramural Fibroids?

Pain from fibroids can be managed with medications like pain relievers or hormonal treatments. In some cases, more advanced treatments like myomectomy or uterine artery embolization may be necessary if pain becomes severe or persistent.

Can Intramural Fibroids Affect My Pregnancy?

Depending on the size and location, fibroids can potentially cause complications during pregnancy, such as preterm birth, placental abruption, or fetal growth restriction. However, many women with fibroids have successful pregnancies without complications.

How Are Intramural Fibroids Monitored Over Time?

Fibroids are usually monitored through regular pelvic exams and imaging tests like ultrasound or MRI. The frequency of monitoring will depend on the size, symptoms, and location of the fibroids.

Can Fibroids Recur After Treatment?

While treatments like myomectomy or uterine artery embolization can effectively shrink or remove fibroids, there is a chance that fibroids may recur over time, particularly if the hormonal environment in the body remains unchanged.

What Happens If Intramural Fibroids Are Left Untreated?

If fibroids are not causing significant symptoms, they may not require immediate treatment. However, if left untreated, fibroids can grow in size, potentially leading to complications like heavy bleeding, pain, or pressure on surrounding organs.

Can Intramural Fibroids Affect My Menstrual Cycle?

Yes, fibroids often cause heavy or prolonged menstrual bleeding, and they may also lead to irregular periods. Women with fibroids may experience more severe menstrual symptoms than those without.

Do Intramural Fibroids Affect Menopause?

Fibroids tend to shrink after menopause due to a decrease in estrogen levels, which is the hormone that stimulates fibroid growth. However, women may continue to experience symptoms related to fibroids until menopause occurs.

Reviewed By Dr. Shaveta Gupta, Principal Consultant, Obstetrics And Gynaecology, Robotic Surgery, Infertility & IVF, Gynaecologic Laparoscopy 10 January 2025.