When you’re told you have uterine fibroids, the next questions are usually about size and number. But there’s another detail that often matters more for your symptoms and your treatment options: where the fibroids sit in the uterine wall. A small fibroid in one location can cause far more trouble than a large one somewhere else. For women weighing their choices in Maryland, DC, and Northern Virginia, understanding fibroid type is key to understanding your treatment.
The three main locations
Fibroids are classified by their position relative to the three layers of the uterus, the inner lining (endometrium), the muscular wall (myometrium), and the outer surface (serosa). Clinicians often use the FIGO classification (a system from the International Federation of Gynecology and Obstetrics) that numbers fibroids from 0 to 8, but the three broad categories are the most useful place to start:
Submucosal fibroids grow just beneath the uterine lining and bulge into the uterine cavity. Even when small, they’re frequently the culprits behind heavy menstrual bleeding and fertility challenges, because they disrupt the lining where a pregnancy would implant and where bleeding is controlled.
Intramural fibroids sit entirely within the muscular wall of the uterus. They’re the most common type and, as they grow, can cause heavy bleeding, pelvic pain, pressure, and an enlarged uterus.
Subserosal fibroids grow outward from the uterus toward the outer surface. Rather than heavy bleeding, they tend to cause “bulk symptoms” including pelvic pressure, a feeling of fullness, bladder urgency or frequent urination, and sometimes back or leg discomfort, by pressing on neighboring organs. When they hang from a stalk, they’re called pedunculated.
Why location drives your symptoms
This is why two women with “the same” fibroids can have completely different experiences. A small submucosal fibroid can cause debilitating bleeding, while a much larger subserosal fibroid might mostly cause pressure, or no symptoms at all. Matching your symptoms to the likely fibroid type helps your care team understand what’s happening and target treatment effectively.
Your symptoms are a clue, but imaging is the answer. The specialists at Surgical Associates use imaging to map the size, number, and location of your fibroids, then explain what your specific pattern means for treatment. Women across Maryland, DC, and Northern Virginia start here.
How fibroid type affects treatment — including UFE
Fibroid location influences which treatments make the most sense:
- Submucosal fibroids that protrude into the cavity can sometimes be removed directly through the cervix with a hysteroscopic procedure without incisions, particularly when they’re the main driver of heavy bleeding.
- Intramural and subserosal fibroids within or on the wall are where minimally invasive, uterus-preserving options like uterine fibroid embolization (UFE) are especially valuable.
UFE works by cutting off the blood supply that feeds fibroids, regardless of how many you have, causing them to shrink. It’s effective across fibroid types: overall, UFE has a success rate above 85%, relieves symptoms in roughly 71–92% of patients, and shrinks fibroids by about 42–83% over the months following the procedure, with high patient satisfaction and a low rate of major complications. Because it treats the whole uterus’s fibroid blood supply at once, UFE is well suited to women with multiple fibroids of different types.
A few nuances are worth an honest mention. Pedunculated subserosal fibroids on a thin stalk are sometimes treated differently, and for women specifically hoping to preserve fertility, the data don’t clearly favor UFE over surgical myomectomy — so fertility goals are an important part of the conversation. The right plan depends on your fibroid map, your symptoms, and your priorities.
The encouraging reality: for the majority of women with symptomatic fibroids, including those with several fibroids in different locations, UFE offers strong, well-documented symptom relief while preserving the uterus. To find out what your fibroid pattern means for you, schedule a consultation. We’ll review your imaging, walk through your options, and answer every question, with no obligation.
The bottom line
Fibroid treatment isn’t one-size-fits-all, and the location of your fibroids — submucosal, intramural, or subserosal — shapes both your symptoms and your best options. Imaging tells the full story, and from there a specialist can match you to the approach most likely to relieve your symptoms while respecting your goals.
Frequently asked questions
Which fibroid type causes the heaviest bleeding? Submucosal fibroids, which grow just beneath the uterine lining and bulge into the cavity, are most strongly associated with heavy menstrual bleeding — even when they’re small.
Which fibroids cause pressure and bladder symptoms? Subserosal fibroids, which grow outward from the uterus, tend to cause “bulk symptoms” like pelvic pressure, fullness, and bladder urgency by pressing on nearby organs.
Does UFE work for all fibroid types? UFE is effective across fibroid types and is especially useful for intramural and subserosal fibroids and for women with multiple fibroids, because it blocks the blood supply feeding them. Some submucosal fibroids may also be treated hysteroscopically. Your specialist will recommend the best fit.
How do I find out what type of fibroids I have? Imaging — typically ultrasound or MRI — maps the size, number, and location of your fibroids. This is the basis for any treatment recommendation.
Can I keep my uterus? Yes. UFE is a uterus-preserving treatment. It shrinks fibroids by cutting off their blood supply without removing the uterus, unlike hysterectomy. Surgical Associates serves Maryland, DC, and Northern Virginia.
Find the right treatment for your fibroids
Your fibroids are unique to you, and so is the right treatment. Contact Surgical Associates to schedule a consultation. Call 240-427-1630 or book online at sacmd.com. We serve patients across Maryland, Washington DC, and Northern Virginia, with locations in Camp Springs, Silver Spring, Reston, and Waldorf. Most insurance plans accepted.
Related reading on sacmd.com:
- Uterine Fibroid Embolization (UFE)
- Fibroid Treatment in Virginia: UFE vs. Endometrial Ablation
- UFE vs. Hysterectomy: What the Long-Term Data Actually Shows
- Adenomyosis and Fibroids Together: How UFE Treats Both
Medically reviewed by Rodeen Rahbar, MD, Surgical Associates, LLC. This article is for general educational purposes and is not a substitute for professional medical advice. Please consult a qualified clinician about your individual situation.
Sources: FIGO Classification of Uterine Fibroids — MRI-based Pictorial Review (UNC Radiology); Diagnosis and Classification of Uterine Fibroids (Int. J. Gynecology & Obstetrics, 2025); Society of Interventional Radiology — Uterine Fibroids and UFE; Uterine Fibroid Embolization — StatPearls (NCBI).
Dr. Rahbar is an esteemed vascular surgeon at Surgical Associates, known for their exceptional contributions to the field of vascular surgery. As a board-certified vascular surgeon with over 20 years of invaluable experience, Dr. Rahbar is a respected authority in the medical community serving Camp Spring, Maryland and the whole community of Maryland. Their unwavering dedication to providing advanced care for patients with diseases of the arteries and veins has earned them a reputation for excellence. Dr. Rahbar’s work embodies a passion for precision and compassion, improving the lives of those they serve, one procedure at a time.