Intramural Fibroid: Definition, Symptoms, Types, & Treatment

By OBGYN Dr. Kenosha Gleaton

Even though fibroids are fairly common, they aren’t frequently talked about. Let’s dissect one of the types of uterine fibroids, known as intramural fibroids, and discuss the causes, symptoms, and treatments associated with them. 

What Is an Intramural Fibroid?

Uterine fibroids (also known as leiomyomas) are noncancerous tumors made of smooth muscle cells and connective tissue. Fibroids grow in or around the uterus and are classified by their location. While some fibroids extend from the wall of the uterus into the pelvis or endometrial cavity (known as exophytic fibroids), intramural fibroids are embedded in the wall of the uterus. [1] Intramural fibroids often go unnoticed as they aren’t as likely to cause symptoms as exophytic fibroids. [1] Researchers aren’t exactly sure how common intramural fibroids are compared to other types, such as subserosal fibroids or submucosal fibroids. Some data suggests that intramural fibroids may be the most common type, and may even be underreported as they are often asymptomatic. [1-3] 

Symptoms of Intramural Fibroids

Fibroid symptoms can vary from person to person and may be dependent on the size or location of the fibroid(s). Some people with fibroids don’t experience any symptoms at all, which is especially common with intramural fibroids. In general, fibroids may cause [4]:

• Abnormal bleeding
• Abdominal or pelvic pressure
• Abdominal or pelvic pain
• Frequent urination
• Pain during sex
• Low back pain
• Constipation

Fertility Complications Due to Intramural Fibroids

All types of fibroids have the potential to cause health complications, including infertility. [5] Research shows that fibroids have been associated with reduced pregnancy rates and live birth rates, and can play a role in recurrent pregnancy loss. [5] Depending on the size and location, fibroids may disrupt the ability for eggs to be released, meet with sperm, or travel to and implant into the uterus. The location of Intramural fibroids gives them the potential to compress the fallopian tubes, which may make it difficult for someone to get pregnant. In addition to this, some fibroids may lead to decreased space in the uterus, preventing a fetus from growing fully. [5] If you have fibroids and are trying to conceive, or if you have other concerns about your reproductive health, you should speak to your healthcare provider. 

Causes and Risk Factors of Intramural Fibroids

We don’t currently know the exact cause of fibroids, but there are a few different factors that could play a role in their formation. Researchers have noticed a genetic component in those with uterine fibroids, although more data is still needed to fully understand this link. [6-8] Hormone levels are also thought to play a role in fibroids, as high levels of estrogen and progesterone tend to be associated with fibroid prevalence. [6-8] Other risk factors for uterine fibroids include [6-8]:

• Race
• Obesity
• Age
• Family and personal health history
• Low levels of vitamin D

More research is needed to understand the exact cause of uterine fibroids, but we do know that some factors can put someone at a higher risk of developing fibroids. Speak to your healthcare provider if you have any questions or concerns. 

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How are Intramural Fibroids Diagnosed?

Diagnosing fibroids is often done with the help of different types of imaging tests. [7] Many people can continue living their lives unaware of their fibroids, whereas others may experience symptoms, infertility, or noticeable abnormalities caught during a regular pelvic or gynecologic exam. [7] If a healthcare provider notices signs of fibroids, they may conduct one or more tests to confirm the presence of fibroids and determine the size or location. Some imaging test examples include ultrasound, MRI, CT, and some minimally invasive procedures such as a hysteroscopy or laparoscopy. [7] With the help of imaging tests, it’s usually fairly straightforward for a healthcare provider to diagnose a fibroid as intramural or exophytic depending on the location. [1] 

How to Treat Intramural Fibroids

Treatment for fibroids isn’t always necessary but may be helpful for those experiencing uncomfortable symptoms or health complications. [7] Fibroid treatment can vary greatly depending on the size and location of the fibroids, as well as someone’s future family planning goals. While some treatment options are more permanent than others, they may not be the best decision for someone hoping to conceive. [7] Additionally, fibroids tend to shrink on their own after menopause, so those nearing or experiencing perimenopause may not need treatment at all. [7] 

Do Intramural Fibroids Need To Be Removed?

Intramural fibroids do not have to be removed unless they are causing uncomfortable or damaging health effects. In most cases, fibroids will shrink on their own after hormone levels drop during menopause. Fibroids are often harmless and can be left alone unless otherwise recommended by a healthcare provider. 

Watchful Waiting

Watchful waiting is a technique used for a few different health conditions, including uterine fibroids. This refers to holding off on any treatment and waiting to see if any other symptoms or complications arise. Often, healthcare providers will have you come in for periodic evaluations to measure any potential changes to the fibroids or symptoms. 

Non-Surgical Treatments

If someone does decide to move forward with treatment, there are a few different non-surgical techniques available. This can vary from prescription medication to the use of sound waves, energy, freezing, and other methods. [9] Most treatments aim to stop or slow the growth of fibroids and when possible, shrink or get rid of them completely. Not all of these options are right for everybody, so speak to your healthcare provider about your future goals and your options for treatment. 

Surgical Options

Surgical treatment options for fibroids range from treating the surrounding blood vessels to the complete removal of the uterus. [9] In some cases, fibroids can be surgically removed while leaving the uterus intact. With intramural fibroids, it can be more difficult to remove fibroids without comprising the rest of the uterus. [9] It’s important to know all of your options before proceeding with any treatments.

Fertility Preservation and Treatment Choices

If someone is hoping to conceive and would like to preserve their fertility, there are a few different options available. As stated, treating fibroids is not always necessary. It is possible to have a healthy pregnancy with uterine fibroids. If someone does choose or is advised to go through treatment, they may opt for fertility preservation methods such as egg freezing, embryo freezing, or by opting for methods that protect fertility. Using focused therapy, it’s possible to target uterine fibroids without comprising the rest of the reproductive tissue. [9] 

Natalist's Role in Your Reproductive Health Journey

Navigating reproductive health can be challenging, time-consuming, and confusing. At Natalist, we are committed to providing you with knowledgeable answers to all of your questions and evidence-based products designed to support you through all stages of parenthood. Support prenatal nutrition with high-quality supplements, maintain healthy vitamin D levels with tasty Vitamin D3 Gummies, or get a read on your fertility with at-home testing kits. Keep learning on the Natalist blog → 

References:

1. 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
2. Fibroids and Fertility. American Society for Reproductive Medicine. ReproductiveFacts.org. Revised 2015. URL. 
3. Intramural Fibroid: Symptoms and Treatment. USA Fibroid Centers. July 4, 2022. URL. 
4. Uterine Fibroids. Cleveland Clinic. August 24 2020. URL. 
5. Freytag D, Günther V, Maass N, Alkatout I. Uterine Fibroids and Infertility. Diagnostics (Basel). 2021;11(8):1455. Published 2021 Aug 12. doi:10.3390/diagnostics11081455
6. Risk Factors of Uterine Fibroids. NIH. Office of Communications. November 2 2018. URL. 
7. Patient FAQ: Uterine fibroids. FAQ074. American Congress of Obstetricians and Gynecologists. July 2022. Retrieved July 2023. URL.
8. Segars JH, Parrott EC, Nagel JD, et al. Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations. Hum Reprod Update. 2014;20(3):309-333. doi:10.1093/humupd/dmt058
9. 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