Intramural Fibroids

Uterine fibroids, also known as uterine leiomyomas or myomas, are one of the most common medical conditions affecting at least one out of every four women. These are benign tumors formed from the muscular layer of the uterus. Women with fibroids may or may not experience any outer symptoms. Therefore, uterine fibroids are often detected only during a routine pelvic examination. On the basis of their location, uterine fibroid tumors can be categorized into three different types: subserosal fibroids, intramural fibroids and submucosal fibroids.


What are Intramural Fibroids?

Intramural fibroids are one of the most common types of uterine fibroids, found in 70% of women of childbearing age. Unlike subserosal fibroids, which develop on the outside covering of the uterus, and submucosal fibroids, which develop just under the lining of the uterine cavity, intramural fibroids develop within the wall of the uterus.

Intramural fibroids begin as small nodules in the muscular wall of the uterus. With time, intramural fibroids may expand inwards, causing distortion and elongation of the uterine cavity. Sometimes these fibroid tumors may grow towards the endometrial cavity to become submucosal fibroids or they may even grow towards the outer surface of the uterus to become subserosal fibroids.


Symptoms of Intramural Fibroids

Intramural fibroids are generally asymptomatic, but in some women, they may cause problems such as:


  • Heavier menstrual bleeding
  • Pelvic pain
  • Pain in back and the back of the legs
  • Constipation and bloating
  • Constant urge to urinate
  • Lower-abdominal pressure or heaviness due to the weight of large intramural fibroids
  • Abnormally large abdomen
  • Pain or discomfort during intercourse, if the fibroids are located in the cervix area
  • In some extreme cases, intramural fibroids may result in uterine hemorrhage


Intramural Fibroids and Infertility

Normally, intramural fibroids have no effect on fertility and pregnancy. However, in about 3% of women, these uterine fibroids are linked with infertility. Women who have multiple intramural fibroids or very large fibroids may find conceiving troublesome.

Intramural fibroids can prevent sperm from entering the uterine cavity, particularly when the fibroids are located at the cervix. These fibroids can also enlarge the uterine cavity, thereby increasing the distance that sperm need to travel to reach the fallopian tubes.

Additionally, intramural fibroids may affect the uterus’ ability to contract, which has a direct impact upon sperm migration and ovum transport.

Implantation of the embryo can also be inhibited by intramural fibroids as they distort the uterine cavity, impairing the blood supply to the endometrium and disturbing the endometrium structure. Even if implantation has occurred successfully, intramural fibroids may interfere with the development of the foetus.

Uterine fibroids usually enlarge as the pregnancy proceeds. Due to this, there is a tussle for space between the growing baby and the intramural fibroids. This struggle may either induce developmental defects in the unborn child or may cause a miscarriage.


Treatment of Intramural Fibroids

If intramural fibroids aren’t interfering with a woman’s ability to get pregnant and aren’t causing any pain, it is likely they will be left untouched. However, if the intramural fibroids are large, treatment might be necessary to reduce the symptoms produced by them.

These uterine fibroids are generally treated by means of three types of surgical procedures:


  1. Removal of one or more intramural fibroids by open abdominal surgery called abdominal myomectomy.
  2. Destruction of the fibroids through uterine artery embolization in which polyvinyl alchol beads are injected into the uterine artery with a catheter to block the flow of blood to the intramural fibroids
  3. Hysterectomy which looks to remove the uterus

At the present time, effective medicines that can permanently shrink these fibroids are not available. Hence, surgical removal is the best option available for the treatment of intramural fibroids.


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