A pedunculated fibroid is a fibroid that is attached to the uterus by a stalk, called a peduncle. Pedunculated fibroids growing outside the uterus are called subserous pedunculated fibroids, and those that grow inside the uterus are called pedunculated submucosal fibroids.
They can grow very big, and one of the largest ones I found was reported in the East African Medical Journal last year. A 37 year old woman had an abdominal swelling that kept growing larger. Her surgeons found a pedunculated fibroid almost 16 centimetres long, that weighed almost one and a half kilograms.
The woman with the fibroid experienced no symptoms, except for the swelling, but other women are not so fortunate with their pedunculated fibroids.
A pedunculated submucosal fibroid can protrude into the vaginal canal, causing pain during intercourse. The American University of Beirut Medical Center reported two women with prolapsed pedunculated sucmucosal fibroids, and in one patient 12 centimetres of that fibroid had prolapsed into the vaginal canal and the rest of it was still in the uterus.
They can cause severe and sharp pains when the stalk is twisted, and although this does not happen to all women, the risk of this happening increases as the fibroid attached to the stalk grows.
Other types of pain associated with these fibroids include uterine cramps, and a feeling of pressure on the uterus and other organs.
Another symptom of pedunculated submucosal fibroids is bleeding in between periods. This bleeding can be light spotting, or a constant bleeding similar to having a light period all the time. Women with continual bleeding find that the bleeding becomes heavier when their time of the month arrives.
Pedunculated fibroids can require immediate surgery if they become twisted. This is because the pain can be so unbearable that the woman experiencing the pain will agree to anything in order to stop it.
Another consequence of the twisted peduncle is a blockage, or kink in the veins that supply the fibroid with blood and nutrients. When the supply is blocked, the fibroid will start to die, which in itself is extremely painful, and can increase the risk of infection.
Uterine Artery Embolization is recommended when the stalk is 2 centimetres or wider. The purpose of this procedure is to block the supply of blood to the fibroids, so that they stop growing and start to shrink and die. But the University of Toronto reported that pedunculated subserousal fibroids were more likely to fail with Uterine Artery Embolization than any other type of fibroid. In Bretonneau hospital in France, doctors are recommending that women who have Uterine Artery Embolization should repeat the procedure after 2 years, as they found that 10% of women experience a regrowth of the fibroids after 2 years. They also found that Uterine Artery Embolization did not stop fibroids from growing back.
Myomectomy is another common procedure for pedunculated fibroids. This is when the surgeon cuts away the fibroid, but repairs the uterus. This surgery isn’t 100% successful, and the University of South Dakota reported a case where a blood vessel in a large pedunculted fibroid had ruptured after the patient had just given birth. They attempted a myomectomy but it was not successful, so they had to perform an emergency hysterectomy.
It is quite common for women to have to sign papers before their surgeries agreeing to a hysterectomy if anything went wrong, so on some occasions women wake up without a uterus.