An intramural fibroid is one that grows in the middle of the uterine wall. Intramural fibroids can cause the uterus to appear larger than it actually is, and make the woman look pregnant, or have a pot belly that cannot go away with dieting or exercise.
Typical symptoms include excessive menstrual bleeding, menstrual clots, painful periods, feeling bulky, constant pelvic pain or pressure, and bladder and colon problems, such as frequent urination, trouble urinating or constipation, which are caused by the fibroid pressing on nearby organs.
When fibroids are very big, they can even block the supply of blood, oxygen and nutrients to other organs, such as the kidneys, and in some cases large intramural fibroids can cause permanent damage to the kidney.
Intramural fibroids can have a negative effect on fertility, and the Mount Sinai School of Medicine in New York reported that women with these types of fibroids experienced 11% less pregnancies than women with submucosal fibroids, and 58% more miscarriages. They also reported an increased risk of caesarean and preterm delivery.
A study carried out at the University of Valencia in Spain concluded that intramural fibroids did not affect the pregnancy rates of women going through IVF. But Baskent University in Turkey found that IVF drugs for stimulating ovulation actually increased the size of intramural fibroids.
The most common treatment option for intramural fibroids is abdominal myomectomy. It is particularly recommended when the fibroids are larger than 5 or 7 centimeters, or when multiple fibroids need to be removed.
An abdominal myomectomy is a procedure where the fibroids are surgically removed through an incision in the abdomen. The surgeon would pull the uterus through the incision and the fibroid is cut out. The uterus is then repaired with sutures then put back into place. As with all surgeries, it carries the risk of bleeding and infection, but something to be aware of is adhesions and scar tissue. Some women have found that their scar tissue adheres the organs, and can lead to further problems such as blocked fallopian tubes.
Another option is Uterine Artery Embolization, a surgical procedure to block the blood vessels that supply the fibroids, so that they become starved of blood, oxygen and nutrients and the tissue dies.
Leeds Teaching Hospital carried out a study on 10 women with intramural fibroids 11 centimeters of larger. Each of them were had a Uterine Artery Embolization, and the doctors followed up their progress after 12 and 36 months. They found that most of the women’s symptoms had subsided, but two of them were still feeling bulky, and two required additional surgery due to damage to their kidneys. After 7 months, one of the patients needed a hysterectomy. Although the doctors concluded that Uterine Artery Embolization was a safe procedure, if you look at the statistics, 20% of the women who went through the surgery needed additional surgery. I also found other statistics to show that the 30% of women who have this surgery experience the return of their symptoms within five years.
Another complication with Uterine Artery Embolization is heavy vaginal bleeding. The McGill University in Canada studied two women who were experiencing abnormal bleeding after going through the procedure for their intramural fibroids. The surgeons performed an endometrial biopsy and found that both women had necrotic fibroids (this is when the tissue has died, due to a lack of blood supply).
Shortly after the biopsy, both women developed a septic uterus and required a hysterectomy. In their report, the doctors concluded that Uterine Artery Embolization – especially when performed intramural fibroids located close to the uterine lining, on carried a high risk of infection. This makes sense, as dead tissue can attract a lot of bacteria.