Uterine fibroids are a common women’s health concern, affecting millions of people during their reproductive years. While these noncancerous growths are almost always benign, they can cause a range of symptoms that impact quality of life. Understanding the different types of fibroids and where they grow in the uterus can help you make informed decisions about treatment options. We’ll explore the four main types of uterine fibroids: intramural, subserosal, submucosal, and pedunculated, and discuss how they differ, where they’re located, and the symptoms they may cause, helping you recognize when it’s time to seek expert care.

What are the Four Types of Fibroids?

Fibroids, also known as leiomyomas or myomas, are classified based on their location in the uterus. The four primary types are:

• Intramural fibroids
• Subserosal fibroids
• Submucosal fibroids
• Pedunculated fibroids

Each type can affect your health and symptoms differently, depending on its size, number, and exact position in the uterus. Let’s start by focusing on the details and the symptoms for each.

Intramural Fibroids

Intramural fibroids are the most common type of uterine fibroid. They develop within the muscular wall (myometrium) of the uterus. As they grow, intramural fibroids can cause the uterus to appear larger than normal, sometimes leading to a sensation of pelvic fullness or pressure.

Symptoms of Intramural Fibroids:

• Heavy or prolonged menstrual bleeding
• Pelvic pain or pressure
• Frequent urination (if the fibroid presses on the bladder)
• Lower back pain

Because intramural fibroids are embedded in the uterine wall, they can sometimes distort the shape of the uterus, potentially affecting fertility or pregnancy, especially if they become large.

Subserosal Fibroids

Subserosal fibroids grow on the outside of the uterus, just beneath the outermost layer called the serosa. These fibroids can extend outward into the pelvic cavity. Subserosal fibroids are less likely to cause heavy menstrual bleeding but are more likely to cause symptoms related to pressure on surrounding organs.

Symptoms of Subserosal Fibroids:

• Pelvic pain or discomfort
• Pressure on the bladder, leading to frequent urination
• Pressure on the rectum, causing constipation
• Abdominal distension or a feeling of fullness

Because subserosal fibroids grow outward, they can become quite large before causing noticeable symptoms. In some cases, a large subserosal fibroid can be felt as a firm mass in the lower abdomen.

Submucosal Fibroids

Submucosal fibroids are less common but can cause the most significant symptoms. These fibroids develop just beneath the lining of the uterine cavity (endometrium) and can protrude into the uterine cavity itself.

Symptoms of Submucosal Fibroids:

• Heavy, prolonged, or irregular menstrual bleeding
• Passing blood clots during menstruation
• Anemia due to excessive blood loss
• Fertility problems or recurrent pregnancy loss

Because submucosal fibroids disrupt the uterine lining, they are most closely associated with abnormal uterine bleeding and can interfere with embryo implantation, making conception more difficult.

Pedunculated Fibroids

Pedunculated fibroids are unique because they grow on a slender stalk that connects them to the uterus, rather than developing directly from the uterine wall. When a pedunculated fibroid forms on the outer surface of the uterus, it is called a pedunculated subserosal fibroid and extends outward into the pelvic cavity. If the fibroid develops on a stalk just beneath the uterine lining, it is known as a pedunculated submucosal fibroid and protrudes into the uterine cavity

Symptoms of Pedunculated Fibroids:

• Pelvic pressure or discomfort
• Sudden, sharp pelvic pain (if the stalk twists, a condition called torsion)
• Symptoms similar to their subserosal or submucosal counterparts

Pedunculated fibroids can sometimes be mistaken for ovarian masses during imaging, and their stalks make them more prone to acute pain if they twist.

What Type of Fibroid is the Most Common?

Intramural fibroids are the most frequently diagnosed type of uterine fibroid. Their location within the muscular wall of the uterus makes them more likely to cause symptoms like heavy periods and pelvic pressure. However, many women may have a combination of different types of fibroids simultaneously.

Which Type of Fibroid Causes the Most Symptoms?

Submucosal fibroids are generally considered the most symptomatic, especially when it comes to abnormal uterine bleeding. Because they grow just beneath the uterine lining and can protrude into the uterine cavity, they disrupt the normal shedding of the endometrium during menstruation. This often leads to heavy, prolonged periods, anemia, and sometimes fertility issues. Even small submucosal fibroids can cause significant symptoms compared to larger fibroids in other locations.

What Type of Fibroids Need to Be Removed?

Not all fibroids require removal. Treatment decisions depend on the size, location, number of fibroids, severity of symptoms, and your reproductive goals. Fibroids that are causing significant symptoms, such as heavy bleeding, severe pain, infertility, or pressure on other organs, are more likely to require intervention.

• Submucosal fibroids are often targeted for removal if they cause heavy bleeding or fertility problems.
• Large intramural or subserosal fibroids may need treatment if they cause pain, pressure, or disrupt nearby organs.
• Pedunculated fibroids may require removal if they twist and cause acute pain.

Minimally invasive treatments like uterine fibroid embolization (UFE) can shrink fibroids and relieve symptoms without surgery, making them an excellent option for many patients.

Recognizing Symptoms of Different Types of Fibroids

Fibroid symptoms can be very different from one person to the next, and in some cases, there may be no symptoms at all. Whether or not you experience symptoms often depends on the size, type, and location of the fibroid. Some women find out they have fibroids by chance during a routine pelvic exam or imaging for something unrelated. Others may start to notice small changes that slowly become more noticeable or disruptive. That’s why it’s so important to listen to your body and check in with your doctor if something doesn’t feel right.

Common signs to watch for include:

• Heavy or prolonged menstrual periods
• Pelvic pain or pressure
• Frequent urination or difficulty emptying the bladder
• Constipation or difficulty with bowel movements
• Lower back pain
• Pain during intercourse
• Difficulty getting pregnant or recurrent miscarriages

If you notice any of these symptoms, it’s important to consult a fibroid specialist for an accurate diagnosis and personalized treatment plan.

How Are the Types of Fibroids Diagnosed?

Diagnosing the type and location of fibroids typically involves a combination of a pelvic exam and imaging tests. Ultrasound is often the first step, providing a clear picture of the uterus and helping to distinguish between the different types of fibroids. In some cases, MRI or hysteroscopy may be used for a more detailed view, especially if submucosal fibroids are suspected.

Take Control of Your Health: Schedule an Appointment at American Fibroid Centers

If you’re dealing with fibroid symptoms or have been diagnosed with uterine fibroids, you’re not alone, and you don’t have to face it without support. At American Fibroid Centers, affiliated fibroid specialists in New York City specialize in minimally invasive treatments like UFE, designed to shrink fibroids and relieve symptoms without major surgery. Don’t let fibroids take control of your life. Schedule an appointment today and discover fibroid treatment options personalized just for you.