🎯Episode 3: Fibroids and Heavy Bleeding

One of the most common reasons women with fibroids seek medical attention is heavy menstrual bleeding.

However, not all fibroids affect menstrual bleeding in the same way.

The impact largely depends on the location of the fibroid within the uterus.

🤔Submucous Fibroids

These fibroids develop just beneath the lining of the uterine cavity and are the type most strongly associated with heavy menstrual bleeding.

Even relatively small submucous fibroids can cause: 

• Heavy periods

• Prolonged bleeding

• Passage of blood clots

• Iron deficiency anemia.

This is because they distort the uterine cavity and increase the surface area of the endometrium.

🤔Intramural Fibroids

Intramural fibroids grow within the muscular wall of the uterus.

When they become large or extend toward the uterine cavity, they may contribute to:

 • Heavy menstrual bleeding

• Prolonged periods

• Pelvic pressure.

The effect is generally less pronounced than with submucous fibroids but can still be clinically significant.

🤔Subserosal Fibroids

Subserosal fibroids grow on the outer surface of the uterus.

These fibroids are least likely to cause heavy menstrual bleeding because they do not directly affect the uterine cavity or its lining.

Instead, they are more commonly associated with: 

• Pelvic pressure

• Abdominal fullness

• Urinary or bowel symptoms due to pressure on nearby organs.

💥Key Message

When a woman with fibroids presents with heavy menstrual bleeding, the first question is not "How big is the fibroid?" but rather "Where is the fibroid located?"

The location of a fibroid often has a greater impact on bleeding symptoms than its size alone.

Dr Rabab Cares 

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 Fibroids Explained

Episode 2: Types of Fibroids

Not all fibroids are the same.

The symptoms, impact on fertility, and treatment options often depend on where the fibroid is located within the uterus.

There are three main types of fibroids:

1. Intramural Fibroids

These develop within the muscular wall of the uterus and are the most common type.

2. Submucous Fibroids

These grow beneath the lining of the uterine cavity and may significantly affect menstrual bleeding and fertility.

3. Subserosal Fibroids

These grow on the outer surface of the uterus and may cause pressure symptoms depending on their size.

🤔Understanding the type of fibroid is often more important than simply knowing its size.

In the next episodes, we will explore each type in detail and discuss how it may affect symptoms, fertility, and pregnancy.

Dr Rabab Cares 

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 #FertilityAwareness

 "You have fibroids."

Few words can cause so much anxiety.

Do fibroids cause infertility? 

Will I need surgery? 

Can I still get pregnant? 

Are all fibroids dangerous?

The truth is that not all fibroids are the same, and not every fibroid requires treatment.

In this series, we will answer the most common questions about fibroids and separate facts from myths.

Welcome to Fibroids Explained.

Dr Rabab Cares 

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#WomensHealth

#Fertility

#Pregnancy

#HeavyPeriods

#PelvicPain

#FibroidsExplainedByDrRabab

 🔑 Key Message

Throughout this series on Müllerian

Not every suspected anomaly is a true anomaly.

An arcuate uterus,

 a septate uterus, 

a bicornuate uterus, 

a unicornuate uterus, 

and uterus didelphys 

may appear similar at first glance, yet they can have very different reproductive implications and management strategies.

This is why accurate diagnosis matters.

Careful assessment, appropriate imaging, clinical correlation, and follow-up are often just as important as the initial scan itself.

As clinicians, our responsibility is not to make the most dramatic diagnosis.

Our responsibility is to make the most accurate one.

Because the correct diagnosis guides the correct counseling, the correct management, and ultimately the best possible outcome for our patients.

Thank you for following this educational journey through Müllerian anomalies.

Dr Rabab Cares 

#DrRababCares 

#MullerianAnomalies 

#WomensHealth 

 #3DUltrasound 

#ReproductiveMedicine 

#FertilityEducation

 🩺 Uterus Didelphys

Uterus didelphys is a rare congenital Müllerian anomaly resulting from complete failure of fusion of the Müllerian ducts during fetal development.

As a result, a woman may have:

• Two separate uterine cavities

• Two cervices

• Sometimes a longitudinal vaginal septum.

Unlike a bicornuate uterus, where there is partial fusion, uterus didelphys results in two distinct uterine structures.

Can women with uterus didelphys become pregnant?

Absolutely.

Many women conceive naturally and may remain unaware of the condition until pregnancy or imaging studies reveal it.

However, uterus didelphys has been associated with an increased risk of:

• Miscarriage

• Preterm birth

• Malpresentation (especially breech presentation)

• Cesarean delivery.

One important consideration is the possible association with:

🩺 OHVIRA Syndrome (Obstructed Hemivagina and Ipsilateral Renal Anomaly)

Patients may present with:

 • Severe dysmenorrhea

• Chronic pelvic pain

• Hematocolpos

• Renal tract anomalies

Accurate diagnosis is essential.

3D ultrasound and MRI can help differentiate uterus didelphys from other Müllerian anomalies and identify associated abnormalities.

The key message:

Having two uteri does not mean a woman cannot have a successful pregnancy.

With appropriate diagnosis and obstetric care, many women achieve excellent reproductive outcomes.

Dr Rabab Cares 

#DrRababCares 

#UterusDidelphys

#MullerianAnomalies

#UterineAnomalies

#OHVIRASyndrome

#3DUltrasound

#HighRiskPregnancy

 🩺 Rudimentary Horn

A rudimentary horn is an underdeveloped uterine structure that may be present in women with a unicornuate uterus.

It can be:

 • Communicating 

• Non-communicating 

• Functional 

• Non-functional

Why is it important?

A non-communicating functional rudimentary horn may lead to:

• Severe dysmenorrhea 

• Chronic pelvic pain

 • Hematometra

 • Endometriosis

However, the most serious complication is:

⚠️ Rudimentary Horn Pregnancy

Although rare, pregnancy can occur within a rudimentary horn through transperitoneal migration of sperm or a fertilized ovum.

Because the horn is unable to expand normally, rupture may occur during the second trimester, resulting in catastrophic intra-abdominal hemorrhage.

Early diagnosis is therefore critical.

Clinical suspicion should increase when ultrasound shows: 

• A gestational sac separate from the main uterine cavity

 • An asymmetric uterine appearance 

• Difficulty identifying continuity with the cervix

3D ultrasound and MRI may help confirm the diagnosis.

Management of rudimentary horn pregnancy is surgical removal due to the high risk of rupture.

The key message:

A rudimentary horn is not simply an anatomical curiosity.

Recognizing it early can be life-saving.

Dr Rabab Cares 

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#RudimentaryHorn #RudimentaryHornPregnancy #UnicornuateUterus #MullerianAnomalies #UterineAnomalies