Submucosal fibroids and the relation to heavy menstrual bleeding and anemia

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.