Subserosal uterine fibroid is a type of mature connective tissue tumor with an abdominal localization. The course of subcutaneous uterine fibroid may be asymptomatic for a long time. As the fibroid tumor grows, it causes a feeling of pressure and pain in the lower abdomen and pelvis, dysuric and dyspeptic disorders. Diagnosis of subserosal uterine fibroid includes gynecological examination on a chair, ultrasound, MRI or CT of the pelvis. Treatment of uterine fibroid can be medicamental, surgical or minimally invasive (EMA, ultrasound ablation)
Subserous (subserous, peritoneal) fibroma develops on the outer surface of the uterus in the peritoneum, sometimes grows on other fibroid nodes. Due to the external growth of the subcutaneous node, the uterus acquires a knobby lumpy shape. Subserosal uterine fibroid may have a wide base or an elongated leg (peduncular fibroma). In the subserotic variant, the fibroma node is sometimes located far from the uterus, in the area of its ligaments. In the case of torsion of peduncular fibroma, edema of the fibroid node and its necrosis develops.
Among the possible causes leading to the development of subcutaneous uterine fibroid, gynecology identifies dishormonal, hereditary, mechanical, somatic factors. Subserosal uterine fibroid develops in women who are in the menstrual period, and is an estrogen-dependent tumor. Fibroid nodes are often diagnosed in patients with early onset of menstruation, ovarian dysfunction, menstrual dysfunction, taking estrogen-containing contraceptives. The growth of fibroid tumors increases during pregnancy, when the level of estrogen increases significantly; and, on the contrary, it slows down during menopause with the extinction of hormonal activity.
The genetic conditionality of the development of uterine fibroids is believed to be associated with hereditary abnormalities in the vascular system. The mechanical factors that increase the likelihood of fibroid-type uterine tumors include frequent diagnostic curettage, surgical termination of pregnancy, traumatic childbirth.
Subserosal uterine fibroid often develops against the background of concomitant extragenital and genital pathology: arterial hypertension, obesity, thyroid diseases, diabetes mellitus, varicose veins, fibrocystic mastopathy, chronic endometritis and cervicitis.
Subserosal fibroid nodes are asymptomatic for a long time. As a rule, they do not disrupt menstrual and reproductive function. The main symptoms of subcutaneous uterine fibroid are periodic aching pains in the abdomen and sacrum, feelings of pressure and heaviness in the pelvic region, soreness during intimacy.
Compression of the bladder by large tumor nodes leads to increased urge to urinate or to incomplete, difficult emptying of the bladder. Subserous fibroids located on the back of the uterus press on the colon, causing constipation and flatulence, or on the spinal nerves, which is accompanied by back pain. When twisting the legs of the subserous fibroma of the uterus, necrosis of the myomatous node develops, clinically manifested by a picture of an acute abdomen.
During gynecological examination on the chair, attention is paid to the uneven increase in the size of the uterus, its bumpy surface. To confirm the diagnosis of subserosal uterine fibroid, a transabdominal or transvaginal ultrasound is performed, with the help of which the localization, growth pattern, size and shape of the tumor node are clarified. If it is difficult to distinguish between subserous uterine fibroids and ovarian cysts, tomographic (pelvic CT, NMR) studies or diagnostic laparoscopy may be required.
The nature of therapeutic tactics in relation to subserosal uterine fibroid is determined by the size and intensity of tumor growth, its clinical manifestations. Conservative management of subserosal uterine fibroid is justified in the case of a small node size, absence of pain syndrome, contraindications to the surgical aid. Hormonal agents that inhibit tumor growth are used in the treatment: androgen derivatives (gestrinone, danazol), progestogens (progesterone, didrogesterone, norethisterone), hormonal IUD “Mirena”, COC (ethinyl estradiol in combination with dienogest, desogestrel or drospirenone), GnRH analogues (gozerelin, buserelin), etc.
Women of childbearing age who are interested in pregnancy can undergo conservative myomectomy – removal of the subserous node with preservation of the uterus. When combining subserosal uterine fibroid with other types of fibroid tumors, hysterectomy is indicated – removal of the uterus by abdominal, laparoscopic or vaginal access. Supravaginal amputation of the uterus is a more gentle intervention.
The issue of ovarian preservation is decided individually, taking into account the patient’s age, the presence or absence of changes in ovarian tissue. Minimally invasive methods of treating fibroid tumors of the uterus include targeted ultrasound ablation of the node and endovascular embolization of the uterine arteries.
Prognosis and prevention
Pregnancy management in patients with subcutaneous uterine fibroid should always take into account the risks of rapid node growth, miscarriage of the fetus, possible postpartum bleeding. Conservative management of subserosal uterine fibroid is carried out under the supervision of a gynecologist-endocrinologist. Cases of malignancy of subserosal uterine fibroid are extremely rare.
Prevention of the development of subcutaneous uterine fibroid consists in mandatory preventive examinations by a gynecologist with pelvic ultrasound, rational selection of contraception, timely therapy of concomitant diseases, prevention of abortions.