You’ve been told you have fibroids. Maybe you’ve even been handed a report mentioning words like “intramural” or “submucosal” — and you left the office with more questions than answers. Here’s something worth knowing: fibroid type matters enormously. The location of a fibroid determines what symptoms it causes, how urgently it needs treatment, and which surgical approach is most appropriate. Dr. Adam Shoman at Hackensack CMIGS maps every patient’s fibroids precisely before recommending any treatment, because a one-size-fits-all approach simply doesn’t work here.
Why Fibroid Type Matters More Than Size
Many women assume that larger fibroids are automatically more serious. That is not always the case. A small submucosal fibroid — one that projects into the uterine cavity — can cause significantly more bleeding and fertility disruption than a much larger fibroid sitting on the outer surface of the uterus. Understanding where your fibroid is located puts you in a much better position to have an informed conversation with your doctor about treatment options.
Intramural Fibroids
Intramural fibroids are the most common type, accounting for approximately 70% of fibroid cases. They grow within the muscular wall of the uterus (the myometrium) itself — neither projecting into the uterine cavity nor extending outward.
Common symptoms include heavy menstrual bleeding, pelvic pressure or fullness, cramping, frequent urination (if the fibroid presses on the bladder), and back or leg pain. Large intramural fibroids can distort the uterine cavity and affect fertility.
Treatment options: Laparoscopic or robotic myomectomy is typically used for intramural fibroids that require surgical removal. The uterine wall is carefully repaired after removal. Medical management may be appropriate for smaller fibroids with manageable symptoms.
Submucosal Fibroids
Submucosal fibroids are the least common type — accounting for roughly 5 to 10% of fibroids — but they cause disproportionately severe symptoms. They grow just beneath the endometrium (inner uterine lining) and project into the uterine cavity itself.
Because they sit inside the cavity, even small submucosal fibroids can cause heavy and prolonged menstrual bleeding, breakthrough bleeding between periods, significant cramping, and anemia. They also have the most significant impact on fertility of all fibroid types, directly interfering with embryo implantation.
Treatment options: Hysteroscopic myomectomy — performed through the cervix with no abdominal incisions — is the procedure of choice for submucosal fibroids. It offers no external scars, same-day discharge, and return to normal activity within a day or two. Multiple studies have shown that hysteroscopic removal of submucosal fibroids can improve fertility outcomes.
Subserosal Fibroids
Subserosal fibroids grow on the outer surface (serosa) of the uterus, projecting outward into the pelvic cavity. They account for approximately 20 to 25% of fibroid cases and often grow large before causing noticeable symptoms.
Because they are located away from the uterine cavity, subserosal fibroids rarely cause heavy menstrual bleeding. Their primary symptoms are related to size and pressure: pelvic heaviness, bloating, back or leg pain, frequent urination, and constipation if they press on the rectum.
Treatment options: Laparoscopic or robotic myomectomy. Because they are on the outer surface, they are often technically straightforward to remove.
Pedunculated Fibroids
Pedunculated fibroids are not a distinct location category — they are a subtype of submucosal or subserosal fibroids that grow on a stalk (called a pedicle) rather than being broadly attached to the uterine wall.
Pedunculated subserosal fibroids extend outward from the uterus on a stalk. They can cause pelvic pain — especially if the stalk twists, which is called torsion and can cause sudden, severe pain. Pedunculated submucosal fibroids extend into the uterine cavity on a stalk and cause significant bleeding and cramping; in some cases, the fibroid can prolapse through the cervix.
Treatment options: Pedunculated subserosal fibroids are typically removed laparoscopically. Pedunculated submucosal fibroids are ideal candidates for hysteroscopic removal.
How Fibroids Are Diagnosed and Mapped
At Hackensack CMIGS, fibroid diagnosis begins with transvaginal ultrasound — fast, non-invasive, and accurate for most cases. When more detail is needed before surgery, MRI provides precise mapping of fibroid number, size, location, and relationship to surrounding structures. For submucosal fibroids, a sonohysterogram (saline infusion sonography) can improve visualisation of the uterine cavity. Diagnostic hysteroscopy may also be performed to directly view the cavity.
Knowing your fibroid type is not just trivia — it directly determines which treatment will be most effective for your situation. If you have received a fibroid diagnosis and want a clear understanding of your options, a consultation with Dr. Shoman provides exactly that.
Frequently Asked Questions
Which type of fibroid causes the heaviest bleeding?
Submucosal fibroids — those projecting into the uterine cavity — cause the most significant bleeding, even when small. They are the most common fibroid type associated with heavy periods and anemia.
Can I have more than one type of fibroid at the same time?
Yes. Many women have multiple fibroids of different types simultaneously. Treatment planning accounts for all fibroids present, their locations, and their contribution to symptoms.
Do all fibroids need to be removed?
No. Many fibroids cause no symptoms and do not require treatment. The decision to treat depends on symptoms, size, location, and the patient’s fertility goals. Dr. Shoman reviews your imaging and presents a personalised recommendation.
Are submucosal fibroids the hardest to treat?
Submucosal fibroids are actually among the most straightforward to treat surgically — hysteroscopic myomectomy removes them through the cervix with no external incisions and a very fast recovery.
Can fibroid type affect my ability to get pregnant?
Yes. Submucosal and large intramural fibroids that distort the uterine cavity have the greatest impact on fertility and miscarriage risk. Subserosal fibroids generally have the least direct impact on conception.
How do I know which type of fibroid I have?
Fibroid type is determined through imaging — transvaginal ultrasound is the first step, with MRI or sonohysterogram used for more precise mapping when needed. Dr. Shoman reviews your imaging in detail at your consultation.
Medical Disclaimer: This blog is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. All content is written for general educational purposes. Individual medical situations vary — always consult a qualified healthcare provider before making any decisions about your health. If you are experiencing symptoms mentioned in this article, please seek evaluation from a licensed physician.
Dr. Adam Shoman, MD, FACOG, MBA, is the founder and lead gynecologist at Hackensack CMIGS. With extensive experience in minimally invasive gynecologic surgery, he specializes in treating complex conditions like endometriosis and fibroids using advanced technologies, such as the da Vinci Surgical System. Dr. Shoman is dedicated to patient-centered care and empowering women to take control of their health. He holds his medical degree from Alexandria University and completed his residency at Mount Sinai in New York. Dr. Shoman is a Fellow of the American College of Obstetrics and Gynecology (FACOG) and is certified in Healthcare Quality (CPHQ).
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