## Most Common Site of Uterine Fibroids **Key Point:** Intramural fibroids account for approximately 60–70% of all uterine fibroids, making them the most frequent location. ### Classification by Location | Site | Frequency | Clinical Features | | --- | --- | --- | | **Intramural** | 60–70% | Enlarges the uterus; causes menorrhagia and dysmenorrhea; may distort cavity | | **Submucosal** | 10–15% | Projects into cavity; severe menorrhagia; infertility; may prolapse through cervix | | **Subserosal** | 20–25% | Projects outward; minimal bleeding; may cause pressure symptoms; can become pedunculated | | **Cervical** | <5% | Rare; may cause cervical stenosis or obstruction during labor | **Clinical Pearl:** Intramural fibroids are the most common because they arise from the bulk of the myometrium, which is the largest component of the uterine wall. Submucosal fibroids, though less common, cause the most severe menorrhagia and are the primary indication for hysteroscopic myomectomy. **High-Yield:** The clinical presentation depends on fibroid location, not just size. A small submucosal fibroid may cause severe bleeding, while a large intramural fibroid may be asymptomatic. ### Pathophysiology Fibroids arise from smooth muscle cells in the myometrium. The intramural region, being the thickest layer, provides the largest substrate for fibroid development. Submucosal fibroids distort the endometrial cavity and increase endometrial surface area, leading to excessive bleeding. Subserosal fibroids, being external, rarely cause menorrhagia unless they compress adjacent structures. [cite:Jeffcoate's Principles of Gynaecology Ch 24]
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