What Is a Subserosal Fibroid?

Subserosal fibroids refer to the majority of fibroids that protrude from the uterine serosal surface, accounting for about 20-30% of fibroids. It is a type of uterine fibroids, which can be divided into intermural, subserosal, submucosal, and broad ligament fibroids according to the location of the uterine muscle wall. The main symptoms are increased menstruation, prolonged periods, and shortened menstrual cycles. The main causes of menstrual increase are submucosal and intermural myomas, while subserosal fibroids have less effect on menstruation. Therefore, subserosal fibroids can grow very large and have other symptoms. Patients often come to the clinic for touching the abdominal mass.

Subserosal fibroids

Subserosal fibroids refer to the majority of fibroids that protrude from the uterine serosal surface, accounting for about 20-30% of fibroids. The main symptoms are increased menstruation, prolonged periods, and shortened menstrual cycles. The main causes of menstrual increase are submucosal and intermural myomas, while subserosal fibroids have less effect on menstruation.

Introduction to Subserosal Fibroids

Due to the growth site and size of fibroids, there may be different degrees of compression symptoms, such as compression of the upper muscles, frequent urination and urgency; compression of the rectum, causing difficulty in urination. When the subserosal fibroid pedicle is twisted, it can cause severe abdominal pain. In this case, surgery is often required to remove the fibroid fibroids to increase the area of the subchamber, increase the secretion of endometrial glands, and increase leucorrhea. Infections can occur with purulent leucorrhea. According to surveys, about 25% to 35% of patients with fibroids may have infertility.

Generally, fibroids will increase rapidly with the increase of the gestational month after pregnancy, which may cause oppression to the fetus, leading to miscarriage or premature delivery. At present, it is not necessary to take anti-surgical treatment for uterine fibroids, but non-surgery can be used to preserve the uterus Interventional treatment can also achieve the effect of curing fibroids. This method of fine needle puncture under ultrasound guidance can stop fibroids from growing, significantly shrinking, and eventually fibrosis. To achieve the purpose of clinical cure. No surgery, safe and pain-free, Does not damage the normal tissues of the uterus, does not affect future pregnancy, has no side effects, is not hospitalized, and does not need to worry about other changes in fibroids, because most fibroids are benign tumors, as long as they can control their growth, there is not much harm to the human body. Currently under ultrasound Interventional therapy is a more reasonable humanized treatment.

Fibroids <2cm, without any clinical symptoms, can be observed for 3-6 months and follow-up once, as long as the growth rate is not fast, you do not need to do any treatment. But you must review the fibroids to see if they grow up, because it is Hormone-dependent tumors, so fibroids may grow rapidly during pregnancy due to an increase in estrogen in the body, and uterine fibroids can cause a series of adverse effects on all stages of pregnancy, childbirth and puerperium.

In early pregnancy, the presence of fibroids is not conducive to the implantation and growth of fertilized eggs in the uterus.The incidence of miscarriage is 2 to 3 times that of non-fibroid pregnant women, and abortions are often incomplete and cause more bleeding.

Large intramuscular fibroids or submucosal fibroids can prevent the fetus from moving in the uterus and cause an abnormal fetal position, leading to an increase in the incidence of lateral and hip positions.Therefore, the rate of cesarean section is also increased.

Fibroids affect the normal contraction of the uterus during delivery, which prolongs the labor process. Fibroids incarcerated in the pelvic cavity (such as cervical fibroids, huge fibroids of the lower uterus, etc.) can block the birth canal and cause difficult labor.

Fibroids can also affect postpartum uterine contractions, causing postpartum hemorrhage or poor uterine recovery.

If fibroids cause poor drainage of the uterine cavity or ulcers on the surface of the fibroids, they are prone to infection and can cause advanced uterine bleeding.

Fibroids can be divided into intermural, subserosal, submucosal, and broad ligament fibroids according to the location of the uterine muscle wall. ^[1]

Subserosal fibroid types

Uterine fibroids can be divided into three types based on the location of their growth:

1. Intermuscular fibroids, which grow in the uterine muscle wall, are the most common.

2. Subserosal fibroids. Fibroids protrude from the surface of the uterus and are covered by a serous layer.

3. Submucosal fibroids, fibroids grow into the uterine cavity, and the surface is covered with a layer of endometrium.

Interpretation of Subserous Fibroids

1. Those who grow under the epidermis of the uterus are called subserosal fibroids. Those who grow in the uterine muscle are called uterine muscle wall, and those who grow myoma fibrils on the inner wall of the uterine cavity are called submucosal fibroids;

2. There is also a fibroid that grows on the surface of the uterine serosa, called a subserosal fibroid, without symptoms of irregular bleeding. Uterine fibroids have a low rate of malignant transformation, which accounts for about (). 5%, a tendency to shrink after menopause;

3. If the tumor grows close to the surface, it is called subserosal fibroid. If it grows in the middle, it is called intermural myoma. If it grows to the uterine cavity, it is called submucosal fibroid. Fibroids can also be pedicled, but are more often pedicled.

Causes of Subserosal Fibroids

Subserosal fibroids refer to most of the growth of fibroids that protrude from the serous surface of the uterus. The main symptoms are increased menstruation, prolonged periods, and shortened menstrual cycles. The increase in menstruation is mainly caused by fibroids in the submucosa and between the muscle walls. Subserosal fibroids have less effect on menstruation. Subserosal fibroids can grow very large and have no other symptoms. Patients often seek treatment by touching a mass in the abdomen.

Fibroids grow in different locations and sizes, which can cause symptoms of compression to varying degrees, urinary frequency and urgency in the compression of the upper muscles; compression of the rectum causes dysuria. Fibroid pedicles can cause severe abdominal pain when twisted. Frequently, surgical resection of fibroids is required. Glandular secretion in the endometrium increases, and leucorrhea increases. If accompanied by infection, purulent leucorrhea may appear. Infertility may occur.

Fibroids grow to the uterine serosa surface, and the surface is covered only by the uterine serosa layer. Only one pedicle is connected to the uterine muscle wall, which is volatile and necrotic due to insufficient blood supply. If the pedicle is twisted and broken, the fibroids fall off to the abdominal or pelvic cavity, forming free fibroids.

Clinical manifestations of subserous fibroids

Subserous fibroid uterine bleeding

It is the main symptom of uterine fibroids and occurs in half or more patients. Among them, periodic bleeding (excessive menstrual flow, prolonged or shortened menstrual cycle) is more, accounting for about 2/3; non-cyclic (continuous or irregular) bleeding accounts for 1/3. Bleeding is mainly caused by intermural fibroids and submucosal fibroids. Periodic bleeding occurs mostly in intermural fibroids, while submucosal fibroids often appear as irregular bleeding. Subserous fibroids rarely cause uterine bleeding. Individual cases have decreased menstrual flow.

The reasons for the large amount of bleeding caused by fibroids are: patients with fibroids often have endometrial proliferation and polyps due to excessive estrogen, resulting in a large amount of menstrual periods; the uterine volume caused by fibroids increases, and the endometrial area increases. Excessive bleeding and prolonged bleeding. Especially for submucosal fibroids, the mucosal bleeding area can reach more than 225cm2 (normally about 15cm2); submucosal fibroids, the mucosal surface often ulcers and necrosis, resulting in chronic endometritis and continuous dripping bleeding; intermural fibroids , Affect the contraction of the uterus and the effect of the capillaries, or the intimal peeling of the submucosal fibroids can not be contracted, resulting in a large amount of bleeding and prolonged duration; larger fibroids can be combined with pelvic congestion, making blood flow strong and abundant Irregular menstruation during menopause.

Excessive menstrual flow or prolonged periods can exist alone or in combination. If coexisted with the shortened (over-frequency) menstrual cycle, a large amount of blood can be lost in a short period of time and severe anemia can result. Submucosal fibroids prolapse out of the vagina and show aperiodic bleeding, which can be very large. Large polypoid fibroids also often cause persistent bleeding.

Subserous fibroid abdominal mass

Lower abdomen mass is often the main complaint of patients with uterine fibroids, which can be as high as 69.6%. Sometimes it may be the only symptom of fibroids. This is often the case for intermural fibroids that grow into the abdominal cavity and do not affect the endometrium, especially at the base of the uterus or pedicled subserosal fibroids. Abdominal masses are often found after uterine fibroids grow out of the pelvic cavity, often in the early morning when the fasting bladder is full. Because the uterus and fibroids are pushed upward, the patient is easy to touch by themselves. If the uterus is larger than 4 to 5 months of pregnancy, it can also be touched when the bladder is not full. Uterine fibroids are generally located in the middle of the lower abdomen, and a few can be located on one side of the lower abdomen, which is hard or uneven. The larger ones are more degenerate, softer and smoother. Most are not growing fast. In the early days of liberation, there were those who had seen doctors since they were 22 years old, mainly due to the oppression of working women in the old society and unconditional medical treatment. Very few growths may be rapid or accompanied by dull pain, and malignant changes should be suspected.

Subserous fibroid pain

About 40% of patients with abdominal pain, backache 25% and dysmenorrhea 45%; also showed lower abdominal pain or low back pain, the severity is not very serious. Pain is caused by tumors compressing pelvic vessels, causing blood stasis, or compressing nerves, or pedicled submucosal fibroids can stimulate uterine contraction. The cervical canal is widened and painful caused by internal discharge from the uterine cavity. Caused by inflammation, adhesion, traction, etc. If individual factors of uterine fibroids are red degeneration, abdominal pain is more severe with fever. Acute severe abdominal pain also occurs when the pedicle of the subserosal fibroid is twisted or the axis of the uterus is twisted. Large subserous fibroids grow into the broad ligament, which can not only compress the nerves and blood vessels to cause pain, but also compress the ureter to cause ureter or hydronephrosis and cause back pain. Those who have severe and progressive dysmenorrhea are often caused by uterine fibroids with adenomyosis or endometriosis.

Subserous fibroid compression symptoms

Mostly occur in uterine and cervical fibroids, or enlarged fibroids in the lower uterine body, filling the pelvic cavity and causing compression of surrounding organs. Compression of the bladder, frequent urination or difficulty in urination, retention of urine, etc .; compression of the ureter can cause hydronephrosis and pyelitis. Fibroids growing in the back wall of the uterus can compress the rectum, cause constipation, and even have difficulty defecation. Compression of the pelvic vein can cause lower limb edema. Compression symptoms are more pronounced in the premenstrual period, which is the reason for the uterine fibroids' congestion and swelling. Bladder or rectal compression can also occur if a subserosal fibroid is incarcerated in the uterine rectal fossa.

Fibroids cause about 30% of compression symptoms, of which 20% are frequent urination, about 10% have difficulty urinating, 3.3% have urinary closure, 5% have urinary retention, 5% have dysuria, 20% have constipation, and 6% have edema in the lower limbs.

Subserous fibroid leucorrhea

Increased leucorrhea accounted for 41.9%. Enlarged uterine cavity, increased endometrial glands, pelvic congestion or inflammation can increase leucorrhea; when submucosal fibroids ulcer, infection, bleeding, necrosis, bloody leucorrhea or purulent leucorrhea, A lot.

Subserosal fibroids infertility and miscarriage

30% of uterine fibroids are infertile. Infertility may be the cause of the visit, and uterine fibroids were found during the examination. The causes of infertility caused by uterine fibroids are many, see the section on uterine fibroids combined with pregnancy. The spontaneous abortion rate is higher than that of the normal population, and the ratio is 4: 1.

Subserosal fibroid anemia

Anemia can occur if chronic bleeding is not treated in time. Before liberation, the majority of working women had anemia due to forced life, despite persistent uterine bleeding and inability to seek treatment. A brief introduction of uterine fibroids in the early days of liberation: 45.25% of patients with hemoglobin in 5-10 grams. And hemoglobin below 5 grams accounted for 12.4%, mostly submucosal fibroids. Severe anemia (below 5 grams) can cause anemia heart disease and myocardial degeneration.

Subserosal fibroids hypertension

Some patients with uterine fibroids are associated with hypertension. Some people who have fibroids with hypertension (except those with a history of hypertension) return to normal after removing fibroids, which may be related to the release of ureteral compression.

Subserous fibroid signs

Fibroids who are less than 3 months pregnant with large uterus are generally not easily accessible through the abdomen. Those who can reach are generally in the middle of the lower abdomen, which is hard and uneven. In patients with thin abdominal walls, the outline of the tumor can be clearly seen, and even its appearance can be seen. Gynecological double consultation can generally find the outline of uterine fibroids more clearly. Fibroids are prominent in the anterior or posterior wall of the uterus; multiple fibroids can touch multiple smooth, hard spherical masses in the uterus; the hard masses protruding from the side of the uterus to the side may be Broad ligament fibroids; those with a significantly enlarged cervix that can touch the normal uterus are indicated as cervical fibroids; the uterus is significantly enlarged and hard, and may be hidden in the uterine cavity or submucosa in the cervical canal Fibroids, such as cervical slack, can often reach smooth spheroid tumors when you extend your fingers; others are exposed at the cervical estuary or even penetrate into the vagina, which can be seen at a glance; but some secondary infections, necrosis, or larger, Can not touch the cervix, it is easy to mix with cervical malignant tumors, uterine inversion and so on.

The location of fibroid growth can also affect the location of the cervix in the uterus. Such as fibroids in the posterior wall of the uterus, the uterine body and cervix can be pushed forward; plus fibroids in the posterior wall of the uterus can develop to the uterine rectal fossa, and even the uterus can be squeezed to the upper part of the pubic bone, and the contour of the uterus can be reached in the lower abdomen. The cervix also moves up, the posterior wall of the vagina swells forward, and the vaginal examination cannot touch the cervix; if it is a broad ligament fibroid, the uterine body is often pushed to the opposite side.

In patients with fibroid degeneration, with the exception of changes in the characteristics and size of palpable sensory masses, their association with the uterine body and cervix is still the same as described above.