Submucosal fibroids and the relation to heavy menstrual bleeding and anemia

Abstract

Objective: The objective of the study was to determine the contribution of submucosal fibroids (SMs) to heavy menstrual bleeding (HMB) and anemia among women with HMB.

Study design: Our retrospective study included premenopausal women who presented to a tertiary care center for HMB between January 2007 and October 2011. All women in this cohort underwent flexible office hysteroscopy (n = 1665) and 259 (15.6%) had SMs. We also reviewed the clinical ultrasounds (n = 914) from these women to determine whether SMs (n = 148) or any fibroids (n = 434) were present in the uterus. Clinical evaluation of bleeding included hemoglobin and pictorial blood loss assessment charts.

Results: In our cohort, hysteroscopically diagnosed SMs were associated with significantly lower hemoglobin (adjusted difference -0.35 g/dL; 95% confidence interval [CI], -0.56 g/dL to -0.13g/dL) and higher risk of anemia (odds ratio [OR], 1.46; 95% CI, 1.04-2.03). Women with ultrasound-diagnosed SMs had lower hemoglobin and anemia, but results were not significant once adjusted for confounders (hemoglobin: adjusted difference -0.21 g/dL; 95% CI, -0.47g/dL to 0.06 g/dL; and anemia: OR, 1.28; 95% CI, 0.82-1.97). Ultrasound-diagnosed fibroids anywhere in the uterus were not associated with hemoglobin (P = .7) or anemia (P = .8). Self-reported pictorial blood loss assessment charts scores did not differ between women with and without fibroids diagnosed by either hysteroscopy or ultrasound (P = .4 and P = .9, respectively).

Conclusion: SMs were related to lower hemoglobin and higher risk of anemia but not self-reported bleeding scores. Diagnostic modality was important: hysteroscopically diagnosed SMs had lower hemoglobin and more anemia than ultrasound-diagnosed SMs. This may explain the inconsistent results in the literature.

Keywords: anemia; office hysteroscopy; pictorial blood loss assessment score; submucosal fibroid; ultrasound.

Figure 1

Office hysteroscopy flowchart Description: Flowchart of the women with office hysteroscopy for heavy menstrual bleeding included in our analyses of submucosal fibroids. Clinical data on ultrasounds are included with data on any fibroids and submucosal fibroids.