Uterine Fibroids are classified by their location (see figure), which effects the symptoms they may cause and how they can be treated. Fibroids that are inside the cavity of the uterus ( Submucous myomas) will often cause bleeding between periods and often cause severe cramping. Fortunately, these fibroids can usually be easily removed by a method called “hysteroscopic resection,” which can be done through the cervix without the need for an incision. Some submucous myomas are partially in the cavity and partially in the wall of the uterus (see illustration below). They too can cause heavy menstrual periods (menorrhagia), as well as bleeding between periods. Many of these submucous fibroids can also be removed by hysteroscopic resection.
Intramural myomas are in the wall of the uterus, and can range in size from microscopic to larger than a grapefruit. Many intramural fibroids do not cause problems unless they become quite large. There are a number of alternatives for treating these, but often they do not need any treatment at all.
Subserous myomas are on the outside wall of the uterus, and may even be connected to the uterus by a stalk (pedunculated fibroid.) These do not need treatment unless they grow large, but those on a stalk can twist and cause pain. This type of fibroid is the easiest to remove by laparoscopy.
While the above illustration shows small fibroids that are only in one area of the uterus, when fibroids get large they can take up the entire wall. In that case the outer part of the fibroid may be subserous, the middle part intramural, and the inner part submucous. The illustration to the right shows a fibroid that is partially intramural and partially submucous. This fibroid would be expected to cause heavy bleeding as well as pressure. The treatment of this type of fibroid depends on many factors, including the women’s desire to retain fertility.
