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SUBSEROSAL FIBROID

DEFINITION

A subserosal fibroid is a benign (non-cancerous) tumor that originates from the muscle tissue of

the uterus and grows outward from the organ’s outermost layer, known as the serosa. These

growths protrude from the uterine wall and may vary in size and symptoms. Medically, they are

also called subserosal myomas, subserosal leiomyomas, or subserous uterine leiomyomas

(Cleveland Clinic, 2023).

Subserosal fibroids are categorized based on their location:

● FUNDAL SUBSEROSAL FIBROID:

Grows at the top of the uterus (the fundus). These are often associated with pelvic

pressure and heavier menstrual bleeding.

● ANTERIOR SUBSEROSAL FIBROID:

Located on the front side of the uterus, where they may compress the bladder and lead to

increased urination.

● POSTERIOR SUBSEROSAL FIBROID:

Develops on the back of the uterus and may press on the bowel or nearby nerves,

potentially causing constipation, back pain, or leg discomfort.

● PEDUNCULATED SUBSEROSAL FIBROID:

Attached to the uterus by a thin stalk (peduncle), this type can cause pain or pressure in

the abdomen in addition to heavier periods and pelvic discomfort.

ETIOLOGY/RISK FACTORS

The exact cause of subserosal fibroids remains unknown but several factors are known to

increase the likelihood of developing them:

● GENETIC FACTORS

Individuals with a family history of fibroids are at a higher risk of developing fibroids

themselves.

● HORMONAL INFLUENCE:

Estrogen and progesterone levels are typically higher between puberty and menopause.

These hormones stimulate the growth of the uterine lining during the menstrual cycle

which can contribute to fibroid development (Stewart et al., 2017).

● ETHNICITY:
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Research indicates that individuals of African descent are more prone to developing

fibroids than those of other ethnic backgrounds (Baird et al., 2003).

● AGE:

Fibroids are more likely to occur as a person gets older, particularly during the

reproductive years. They are uncommon before the onset of menstruation and often

decrease in size after menopause due to lower hormone levels.

● DIETARY HABITS:

A diet rich in red meat and low in fruits and vegetables along with alcohol consumption

may elevate the risk of fibroids (Wise et al., 2011).

SIGNS & SYMPTOMS

Some common subserosal fibroid symptoms include:

● Pelvic pain

● Lower back pain

● Back of leg pain (sciatica)

● Frequent need to urinate

● Constipation or bloating

● Abdominal pain

● Painful sex

DIAGNOSTIC

Several diagnostic techniques are available to evaluate uterine fibroids and other conditions

affecting the uterus:

● SONOHYSTEROGRAPHY (SALINE INFUSION SONOGRAPHY)

This procedure involves the gentle infusion of a small amount of sterile saline into the

uterus via a thin catheter. The saline helps to expand the uterine cavity providing clearer

ultrasound images of the inner uterine lining and any abnormalities.

● COMPUTED TOMOGRAPHY (CT) OR MAGNETIC RESONANCE IMAGING

(MRI) SCANS

When an ultrasound does not provide enough detail a computed tomography (CT) or

magnetic resonance imaging (MRI) may be used. These imaging techniques offer more

detailed cross-sectional views of the uterus and surrounding pelvic structures.

● TRANSABDOMINAL ULTRASOUND

A handheld ultrasound transducer (wand) is pressed against the abdomen to visualize the

uterus and pelvic organs.

● TRANSVAGINAL ULTRASOUND

An ultrasound wand is inserted through your vagina to visualize your uterus and pelvis in

areas not possible with a transabdominal ultrasound.

● HYSTEROSCOPY:

In this procedure a thin, flexible tube with a light and camera is inserted through the

vagina and cervix into the uterus. This allows direct visualization of the uterine cavity

and can help in diagnosing and sometimes treating fibroids or other intrauterine issues.
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MANAGEMENT/TREATMENT

NON-SURGICAL TREATMENTS FOR SUBSEROSAL FIBROIDS

● UTERINE FIBROID EMBOLIZATION (UFE)

UFE is an invasive procedure that blocks the blood supply to fibroids causing them to

shrink over time. A thin catheter is inserted into an artery in the groin or wrist and guided

to the uterine arteries. Tiny particles are then injected to block the vessels supplying the

fibroids reducing their size and symptoms.

● UTERINE FIBROID ABLATION (RADIOFREQUENCY ABLATION)

This treatment uses high-energy radiofrequency waves to generate heat which destroys

fibroid tissue. A small needle is inserted into the fibroid using laparoscopic or

transvaginal guidance. The heat coagulates the fibroid tissue which is reabsorbed by the

body.

SURGICAL TREATMENTS FOR SUBSEROSAL FIBROID

● MYOMECTOMY

It involves the removal of fibroids while leaving the uterus intact. Depending on the size and

location of the fibroids, myomectomy can be done through an open abdominal incision,

laparoscopically or with robotic assistance

DRUG THERAPIES

HORMONAL THERAPY
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● GONADOTROPIN-RELEASING HORMONE (GNRH) ANALOGUES

This treatment reduces the size of fibroids by changing the concentration of multiple hormones.

Progestin-Releasing Intrauterine Device (IUD): A birth control method that helps decrease

blood loss and pain associated with menstruation.

● SELECTIVE PROGESTERONE RECEPTOR MODULATORS (SPRMs)

A hormone treatment that reduces the size of fibroids by changing the concentration of

progesterone.

● ORAL CONTRACEPTIVES

Birth control pills that help regulate the menstrual cycle and reduce heavy bleeding.

NON-HORMONAL MEDICATION

● NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)

These treat cramping and pain caused by fibroids.

● TRANEXAMIC ACID (TA)

This helps boost the blood’s ability to clot which can help decrease the amount of vaginal

bleeding.

FIBROIDS DURING PREGNANCY

Fibroids may cause complications in pregnancy depending on their size or fibroid cluster. The

hormones of pregnancy can cause fibroids to grow bigger.

POSSIBLE COMPLICATIONS:

● Abnormal fetal position – breech presentation

● Preterm birth or miscarriage

● Placenta previa (placenta covering the cervix)

● Postpartum hemorrhage (excessive bleeding after giving birth)

Subserosal fibroids tend to have less impact on fertility compared to other types depending on

their size and location. They are not usually associated with pregnancy complications or heavy

menstrual bleeding.

Subserosal fibroids may also impact the function of other organs (such as the bowel and

bladder) if they put too much pressure on them.

REFERENCES

American College of Obstetricians and Gynecologists. (2021). Uterine fibroids. ACOG.

[Link]

Baird, D. D., Dunson, D. B., Hill, M. C., Cousins, D., & Schectman, J. M. (2003). High

cumulative incidence of uterine leiomyoma in Black and White women: Ultrasound evidence.

American Journal of Obstetrics and Gynecology, 188(1), 100–107.

[Link]

Cleveland Clinic. (2023). Uterine fibroids. [Link]

uterine-fibroids

Mayo Clinic Staff. (2023). Uterine fibroids. Mayo Clinic. [Link]

conditions/uterine-fibroids/diagnosis-treatment/drc-20354294

Stewart, E. A., Laughlin-Tommaso, S. K., Catherino, W. H., Lalitkumar, P. G. L., Gupta, D., &

Vollenhoven, B. (2017). Uterine fibroids. Nature Reviews Disease Primers, 3(1), 1-18.

[Link]

Wise, L. A., Palmer, J. R., Harlow, B. L., Spiegelman, D., Stewart, E. A., & Rosenberg, L.

(2011). Reproductive factors, hormonal contraception, and risk of uterine leiomyomata in

African-American women: A prospective study. American Journal of Epidemiology, 165(2),

157–164. [Link]