Types of fibroids
- Submucosal: just beneath the lining, growing into the cavity; even small ones are linked to bleeding and infertility.
- Intramural: within the uterine wall; symptoms depend on size.
- Subserosal: on the outer surface; usually cause pressure symptoms.
- Pedunculated: attached by a stalk; rarely twist and cause pain.
Current classification: FIGO fibroid types (0-8)
To describe the position of fibroids in a common language, the classification of the International Federation of Gynecology and Obstetrics (FIGO) is used today. The position of a fibroid relative to the uterine cavity, the uterine wall and the outer surface is given a type number from 0 to 8. The type directly affects symptoms, the effect on fertility and which treatment is suitable.
- Type 0: Pedunculated, entirely inside the cavity (submucosal).
- Type 1: Submucosal; less than half within the wall.
- Type 2: Submucosal; half or more within the wall.
- Type 3: Entirely within the wall, touching the lining (endometrium).
- Type 4: Entirely within the uterine wall (intramural).
- Type 5: Subserosal; half or more within the wall.
- Type 6: Subserosal; less than half within the wall.
- Type 7: Pedunculated, attached to the outer surface (pedunculated subserosal).
- Type 8: Other locations, such as the cervix, or fibroids not attached to the uterus.
Fibroids that extend from the cavity to the outer surface are given two numbers (for example type 2-5). Types 0, 1 and 2 are usually treated hysteroscopically, while outward-growing fibroids are treated by laparoscopy or open surgery when needed.
Symptoms
- Heavy, prolonged periods and anaemia
- Pelvic pain, painful periods, pain during sex
- Pressure symptoms such as frequent urination or constipation
- Abdominal swelling or a palpable mass
Do fibroids affect fertility?
Submucosal fibroids that distort the cavity lower pregnancy rates and increase miscarriage risk, so hysteroscopic removal is recommended. The effect of intramural fibroids depends on size and position. Subserosal fibroids that do not affect the cavity usually have no effect. Assessing fibroids before IVF is an important part of planning.
Diagnosis
Usually by transvaginal ultrasound; saline sonohysterography or hysteroscopy assesses the cavity, and MRI is used in complex cases.
Treatment options
- Observation for fibroids without symptoms.
- Medication: treatments that reduce bleeding, a hormonal IUD or pre-operative shrinking.
- Hysteroscopic myomectomy: cavity fibroids removed through the vagina without incisions.
- Laparoscopic myomectomy: suitable fibroids removed by keyhole surgery with faster recovery.
- Open myomectomy: for many or very large fibroids.
- Hysterectomy: for women who do not want children and have not benefited from other treatments.
After uterus-sparing surgery, pregnancy timing and mode of birth are planned according to the extent of the operation.
Frequently Asked Questions
Can fibroids become cancer?
Can I get pregnant with fibroids?
Sources
- ACOG Practice Bulletin No. 228: Management of Symptomatic Uterine Leiomyomas, 2021.
- Munro MG, Critchley HOD, Fraser IS; FIGO Menstrual Disorders Committee. The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions. Int J Gynaecol Obstet. 2018;143(3):393-408.
- Totally inverted cervix due to a huge prolapsed cervical myoma simulating chronic non-puerperal uterine inversion. International Journal of Surgery Case Reports, 2014.
The information on this website is for general information only and does not replace a medical consultation.
Related pages
Videos on this topic
2:04 Do fibroids stand in the way of pregnancy?
How a fibroid affects pregnancy depends more on where it is than on its size. The video explains which fibroids may need surgery before pregnancy.
2:52 What are fibroids and how are they treated?
Fibroids are benign tumours arising from the uterine muscle. The video covers their symptoms, possible effects on pregnancy and the role of medication.
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