Which fibroid type projects to the exterior of the uterus and is least likely to cause abnormal uterine bleeding?

• A. Subserosal
• B. Submucosal
• C. Intramural
• D. Pedunculated

Answer: (A)

The key idea is that the location of a fibroid determines how it affects bleeding. Submucosal fibroids grow into the uterine cavity and distort or invade the endometrium, leading to abnormal heavy or irregular uterine bleeding. In contrast, subserosal fibroids grow outward from the uterus toward the serosal surface and often protrude externally; because they lie on the outer surface and do not distort the endometrial cavity, they are less likely to cause abnormal uterine bleeding. A fibroid that projects to the exterior is subserosal, and while it can cause bulk symptoms, bleeding is not its typical issue. Pedunculated fibroids are usually subserosal or submucosal attached by a stalk, but the outward-projecting type remains subserosal, which is why it’s the best choice for “least likely to cause abnormal uterine bleeding.”