Principal Director & Unit Head, Obstetrics and Gynaecology, Max Hospital, Gurugram
Part 3 of 9 in Benign Growth in Uterus Causing Gynaecological Problems
Diagnosing and Classifying Fibroids by Location
August 25, 2024
Fibroids are diagnosed on ultrasound, with MRI used to pin down the exact location when needed. Both diagnose the fibroid's size, location and number, all of which shape the treatment plan.
Classification by location
Fibroids are classified by where they sit relative to the uterine wall: intramural fibroids sit within the muscular wall, subserosal fibroids grow outward on the outer surface, and submucosal fibroids grow inward into the uterine cavity. This location, more than size alone, determines surgical approach and urgency.
Does every fibroid need to be removed?
Asked directly whether a 5cm fibroid seen on scan should automatically be surgically removed, Dr. Lal was clear that size alone doesn't decide this. A fibroid outside the uterus causing no symptoms doesn't need surgery. A fibroid inside the uterine muscle causing problems, or one obstructing a patient trying to conceive or undergo IVF, often does. Symptoms, location and the patient's fertility goals all have to be weighed together, not just the size on a scan.
This article is based on a Jivo Masterclass session conducted by Dr. Suman Lal, Principal Director & Unit Head, Obstetrics and Gynaecology, Max Hospital, Gurugram. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for a gynaecology consultation or a second opinion? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass: Dr. Suman Lal taught doctors across Africa on August 25, 2024.
FROM THE LIVE Q&A
Jivo Doctor Partner (name unclear from transcript)
How exactly do fibroids cause throbbing and burning pain during urination, and does it predispose patients to UTIs?
Dr. Suman Lal
Since the bladder sits anterior to the uterus, a fibroid growing on the front surface of the uterus can press into and separate the bladder, causing difficulty passing urine and the resulting pain sensation.
Frequently Asked Questions
Can tranexamic acid be used in treatment, like reducing the size of a myoma?▼
No. Tranexamic acid doesn't reduce the size of a fibroid. It works by promoting clot formation, so it reduces heavy bleeding caused by a fibroid, but has no effect on the fibroid's size.
How far can progesterone hormone reduce the size of a fibroid?▼
Progesterone reduces fibroid size by only around 20%. It's given to women waiting for surgery or unable to have surgery who have heavy bleeding, not routinely to patients without symptoms.
What is the management of fibroids using medication without surgery, and what are the possibilities?▼
If bleeding is heavy and the fibroid isn't inside the cavity, medical management with painkillers, oral contraceptive pills, and GnRH agonist injections is possible. GnRH injections reduce fibroid size but the effect reverses within six months to a year of stopping, so medical management is generally a one-to-two year bridge, not a permanent solution, and is most useful pre-menopause, pre-surgery, or pre-pregnancy attempts.
What is the role of the gonadotropin agonists used in India, Lupron and Goserelin?▼
Both are effective at reducing fibroid size, by around 40-50%. Different centres use different ones, but either can be used.
Do you suggest that a scan measuring a 5cm fibroid should be surgically removed?▼
Not automatically. If the 5cm fibroid is inside the uterus causing heavy bleeding or obstruction, yes. If it's outside the uterus and not causing any problem, there's no need to operate. If it's in the muscle layer and the patient is trying to conceive or undergo IVF, removal is often needed. Symptoms, location and fertility goals all have to be weighed together, not size alone.
How are fibroids classified?▼
By location relative to the uterine wall: intramural (within the muscle wall), subserosal (growing outward), or submucosal (growing into the uterine cavity).
Should every 5cm fibroid be surgically removed?▼
Not necessarily. Size alone doesn't decide this, location, symptoms, and whether the patient is trying to conceive matter more than the measurement alone.
In This Series: Benign Growth in Uterus Causing Gynaecological Problems
- 1.Uterine Fibroids
- 2.What Are Uterine Fibroids? Risk Factors and Symptoms
- 3.Diagnosing and Classifying Fibroids by Location
- 4.Fibroids, Fertility, Pregnancy Risk and Menstrual Pain
- 5.Medical Management: Painkillers, Progesterone and GnRH Agonists
- 6.Uterine Artery Embolization: When It Works and When It's Contraindicated
- 7.Surgical Removal: Hysteroscopic, Laparoscopic and Robotic Myomectomy
- 8.Beyond Fibroids: PCOS, Endometriosis and Infertility
- 9.Preventing Adhesions After Myomectomy: What Actually Works