Types of Uterine Fibroids

By Paul D. Indman, MD | September 19, 2011

Dr. Indman believes that women should be as informed as possible so they can be directly involved in making choices about their own health care. This is especially true for the treatment of heavy bleeding. As there are a bewildering number of treatment options available, Dr. Indman takes extra time with his own patients to be sure they make the best possible individual decisions. Dr. Indman has helped pioneer techniques in Gynecology and minimally invasive surgery. He has taught physicians locally, nationally, and internationally, and has published chapters in textbooks on advanced surgical techniques, and in numerous medical journals.

fibroid-locations 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 fibroid-in-cavity 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.

Editor's Note: This post was picked up from Uterine Fibroids blog: An Expert Speaks Out.The blog posts do not intend to diagnose, treat, or cure any condition and are not a substitute for consultation with a physician. The postings are presented for educational purposes only.

AboutOurBloggers

	GUEST BLOGGER David Holtz, MD David Holtz is a practicing Gynecologic Oncologist with Main Line Gynecologic Oncology Associates and the Director of the Division of Gynecologic Oncology for the Main Line Health System. He is the first gynecologic surgeon in Pennsylvania to perform procedures for uterine and cervical cancer with the daVinci Robot, and he is a Clinical Assistant Professor with Thomas Jefferson University Hospital and the Lankenau Institute for Medical Research. Dr. Holtz’s clinical interests include minimally invasive surgery for women’s cancers and nanoparticles in the treatment of ovarian cancer.
	GUEST BLOGGER Donald Shuwarger, MD Dr Don Shuwarger is a board-certified general ob/gyn practicing in northwest North Dakota. His career spans 26 years, most of which has been spent serving smaller cities. He earned his MD from Baylor College of Medicine in 1981 where he completed his ob/gyn residency in 1985. He earned his MBA from UMass-Amherst in 2005. In 2008 Shuwarger took a sabbatical to join the US Antarctic Program as a physician at McMurdo Station and the new Amundsen-Scott South Pole Station. From 2009 - 2010 he was the Chief Medical Officer at the US Army Kwajalein Atoll in the Marshall Islands. He has one 22 year old daughter who is an EMT and is studying to be a registered nurse.
	GUEST BLOGGER Amy Tuteur, MD Dr Tuteur is an obstetrician gynecologist. She received her undergraduate degree from Harvard College, her medical degree from Boston University School of Medicine, and did her internship and residency at Boston's Beth Israel Hospital. Dr Tuteur is a former clinical instructor at Harvard Medical School. She left the practice of medicine to raise her four children. She blogs at The Skeptical OB.
	ISSUES IN INFERTILITY Reproductive Medicine Associates of New York RMA of New York offers patients up-to-date, appropriate infertility treatment in a caring, compassionate manner.
	ISSUES IN INFERTILITY Eric Flisser, MD Dr Flisser, MD is the Medical Director of Reproductive Medicine Associates of New York. He is Board Certified in Reproductive Endocrinology & Infertility and in Obstetrics & Gynecology. He is an Associate Member of the American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility. He is also a member of the Nassau County Obstetrics and Gynecology Society, New York-Metropolitan Embryologist Society, and the American College of Obstetricians and Gynecologists. His professional interests include reproductive surgery, in vitro fertilization, and oocyte donation.
	ULTRASOUND Joe Antony, MBBS, MD Dr Antony's expertise includes radio diagnosis, ultrasound and color Doppler imaging, x-ray imaging, CT imaging, and MR imaging. Presently, he is a consultant radiologist at PVS Hospital in Cohin, Kerala, India and is consultant radiologist and CEO of Ultrascan Centre, which is a color Doppler and ultrasound imaging clinic in Cochin, India.You can see his full ultrasound gallery at ultrasound-images.com and sites.google.com/site/drjoea. He blogs at cochinblogs.blogspot.com and ultrasound-images.blogspot.com.
	UTERINE FIBROIDS Paul Indman, MD Dr Indman, MD has helped pioneer techniques in gynecology and minimally invasive surgery. He has taught physicians locally, nationally, and internationally, and has published chapters in textbooks on advanced surgical techniques, and in numerous medical journals. Dr Indman is an editorial advisor on OBGYN.net. You can read more about him and his work on his eFibroids Web site.

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TopicIndex

Adhesions
Breast Health and Breast Care
Contraception
Electronic Health Records (EHRs)
Endometriosis
Fetal Monitoring
Fibroids
Gestational Diabetes
Gynecologic Oncology
Hysterectomy
Infertility
In Vitro Fertilization (IVF)
Laparoscopy
Malpractice

Menopause
Osteoporosis
Polycystic Ovary Syndrome
Postpartum Depression
Pelvic Pain
Premenstrual Syndrome/Premenstrual Dysphoric Disorder (PMS/PMDD)
Pregnancy and Birth
Sex-related Issues
Ultrasound
Urogynecology
Uterine (Endometrial) Polyps
Weight Management
Young Women

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