Submucosal Fibroid: Definition, Symptoms, Causes, Treatment, & More

By OBGYN Dr. Kenosha Gleaton

Originally published 07/14/2023. Updated for accuracy and relevancy on 05/09/2024

Leiomyomas, also known as uterine fibroids, are noncancerous tumors found in or around the uterus. Fibroids occur in up to 80% of women and people assigned female at birth (AFAB). [1] There are a few different types of fibroids, including intramural, subserosal, and submucosal.

What Is a Submucosal Fibroid?

Fibroids grow in or around the uterus and can be classified into different types based on their location. Exophytic fibroids refer to growths that begin in the wall of the uterus and extend to the inside of the endometrial cavity (submucosal) or into the pelvis and surrounding space (subserosal). [2] Submucosal fibroids are the least common type of myoma, only making up about 5% of all fibroids. [2] Submucosal fibroids can sometimes be pedunculated, meaning they are attached to the uterus by a stalk. It’s possible for submucosal fibroids to prolapse (protrude) into the vagina or cervical canal. [2] 

Fibroids are made up of smooth muscle cells and connective tissue. Researchers haven’t been able to determine an exact cause, but there is reason to believe that genetics, hormones, and age are all correlated. [1,3] 

Symptoms of Submucosal Fibroids

The location and size of fibroids can have an impact on symptoms. It’s possible that someone with fibroids may not have any symptoms at all. In general, fibroids may cause [3-4]:

• Abnormal bleeding
• Abdominal or pelvic pressure
• Abdominal or pelvic pain

While submucosal fibroids are less common, they are also more likely to cause symptoms. Submucosal fibroids develop beneath the innermost layer of the uterus and tend to result in heavy bleeding. [5] Fibroids also have the potential to cause pregnancy and fertility complications, painful sex, fatigue, and more. [5] 

Potential Complications Due to Submucosal Fibroids

Submucosal fibroids are unique to intramural or subserosal fibroids, as they develop within the inner lining of the uterus and can extend into the uterine cavity. Some potential complications of this include infertility, anemia, torsion, and prolapse. [5-7] Heavy menstrual bleeding can lead to a drop in red blood cells, which may develop into anemia. Anemia can be a draining condition, leading to fatigue, low energy, dizziness, and shortness of breath. [5] Submucosal fibroids can also prolapse, meaning they may drop down into the cervical canal.  This can cause severe pain and bleeding and will need to be removed by a healthcare professional. [6] Additionally, pedunculated fibroids may twist (known as torsion) which would result in pain, bleeding, and in some cases, infection. [7] Immediate intervention is usually required for fibroid torsion. Seeking out a healthcare professional if you notice any signs of fibroids or are experiencing abnormal bleeding or pain is the best way to prevent complications. 

Causes and Risk Factors of Submucosal Fibroids

We still aren’t exactly sure what causes uterine fibroids, but a few different factors are connected to their presence. [1,3,4] Researchers believe that family history, genetics, and hormones are all important factors. Additionally, there are some risk factors that may increase someone’s chances of developing uterine fibroids, such as [1,3,4]:

• Race: Fibroids are more commonly found in black women.
• Age: Fibroids are most commonly seen in people aged 30 to 40.
• Obesity
• Family history of fibroids
• Vitamin D deficiency (read more about vitamin D and fibroids)
• High blood pressure
• Use of soybean milks

Some factors can also decrease someone's risk of having fibroids, such as having multiple successful pregnancies, and the long-term use of hormonal contraceptives. [4] 

How are Submucosal Fibroids Diagnosed?

Oftentimes, fibroids will be discovered during a standard pelvic or gynecological exam. Because fibroids are often asymptomatic, they may go unnoticed for long periods of time. It is also possible to develop fibroids after menopause. If a healthcare provider notices an abnormal shape or feel to the uterus, they may investigate further to confirm the presence of fibroids. [8] There are a few different imaging tests or procedures that can be completed in order to confirm the presence of fibroids or to get a better understanding of the location, size, and number of fibroids [8]:

• Ultrasound
• Magnetic resonance imaging (MRI)
• Computed tomography (CT)
• Sonohysterography
• Hysterosalpingography (HSG)
• Hysteroscopy and laparoscopy

Once a healthcare provider has a better idea of where the fibroids are located, they will be able to diagnose the tumor as a submucosal, subserosal, or intramural fibroid. A submucosal fibroid will be located on the inner lining of the uterus and may or may not extend out into the endometrial cavity. [5] 

How to Treat Submucosal Fibroids

Treatments for fibroids vary greatly depending on the location, size, age, and fertility goals. Some treatments may be useful for temporary symptom relief, while others can be more invasive and longer lasting. Read my comprehensive Guide to Fibroid Pain Relief for more information. 

Prescription Medications

There are many different prescription options available that may help reduce fibroid symptoms or size. Some healthcare providers recommend hormonal birth control to manage painful periods or heavy bleeding. [1] This may be a good option if someone has a submucosal fibroid that causes abnormal spotting or bleeding between periods. There are also hormone agonists and antagonists that interfere with how the body produces hormones. These may stop the menstrual cycle or vaginal bleeding and may or may not shrink fibroids. [1] 

Medical Treatments

Medical intervention for treating fibroids can range from non-invasive procedures to surgical removal of the fibroids and/or the uterus. [1,4] Some people opt for non-invasive or minimally invasive procedures such as MRI-guided ultrasound, uterine artery embolization, or endometrial ablation. [1,3,4] These methods involve targeting and attempting to destroy the fibroids themselves, or targeting the blood vessels that supply the fibroids with oxygen. Some healthcare providers may recommend a myomectomy, which involves removing the fibroids and leaving the uterus intact. Some may be potential candidates for hysterectomy, which is the removal of the uterus. Speak to your healthcare provider about what fibroid treatment options may be right for you.

When to Seek Medical Attention

You should always seek out a healthcare provider if you have concerns or questions about your health. Fibroids can often go unnoticed and may not cause any harm or symptoms, whereas other people may experience severe complications or painful side effects. [3,4] If you experience abnormal uterine bleeding, fever, extreme pain, or any other sudden and uncomfortable symptoms, you should seek medical attention as soon as possible. [5] 

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References:

1. Sohn, G S. Cho, S. Kim, Y M. Cho, C-H. Current medical treatment of uterine fibroids. Obstet Gynecol Sci. 2018;61(2):192-201.  Published online February 13, 2018. DOI: https://doi.org/10.5468/ogs.2018.61.2.192
2. Wilde S, Scott-Barrett S. Radiological appearances of uterine fibroids. Indian J Radiol Imaging. 2009;19(3):222-231. doi:10.4103/0971-3026.54887
3. Patient FAQ: Uterine fibroids. FAQ074. American Congress of Obstetricians and Gynecologists. July 2022. Retrieved June 2023. Medical citation URL.
4. Florence AM, Fatehi M. Leiomyoma. [Updated 2023 Jan 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538273/
5. SUBMUCOSAL FIBROIDS: WHAT ARE THEY? USA Fibroid Centers. October 14 2020. Medical citation URL. 
6. Parker, W. Uterine fibroids (leiomyomas): Prolapsed fibroids. UpToDate. January 12 2022. Medical citation URL. 
7. Le D, Dey CB, Byun K. Imaging findings of a torsed pedunculated uterine leiomyoma: A case report. Radiol Case Rep. 2019;15(2):144-149. Published 2019 Nov 28. doi:10.1016/j.radcr.2019.11.001
8. Uterine Fibroids. Mayo Clinic. September 21 2022. Medical citation URL. Accessed June 2023.