Fibroids

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 (intracavitary myomas)  will usually cause bleeding between periods (metrorrhagia) 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.  Submucous myomas are partially in the cavity and partially in the wall of the uterus.  They too can cause heavy menstrual periods (menorrhagia), well as bleeding between periods.  Some of these can also be removed by hysteroscopic resection. 
Intramuralmyomas are in the wall of the uterus, and can range in size from microscopic to larger than a grapefruit.  Many of these 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.    A fibroid may even be connected to the uterus by a stalk (pedunculated myoma.)  These do not need usually treatment unless they grow large, but they can twist and cause pain.  This type of fibroid is the easiest to remove by laparoscopy