Treatment of FIGO Type 4 Uterine Fibroids

Understanding FIGO Type 4 Fibroids

• FIGO Type 4 fibroids are pedunculated submucosal fibroids that project entirely into the uterine cavity with no intramural component, making them uniquely amenable to hysteroscopic removal 1

Primary Treatment Approach

• Hysteroscopic myomectomy is the procedure of choice for pedunculated submucosal fibroids less than 5 cm in diameter, providing shorter hospitalization and faster return to usual activities compared to laparoscopic or open myomectomy 1
• Symptom improvement and quality of life scores are equivalent to other surgical approaches at 2-3 months 1

Alternative Treatment Options

• Patients undergoing UAE for submucosal fibroids can experience fibroid expulsion, with one retrospective study demonstrating a 50% rate of complete expulsion with low complication rates 1
• UAE causes persistent decreases in pain and heavy menstrual bleeding, with an average decrease in fibroid size greater than 50% at 5 years 4

Special Considerations

• Hysteroscopic myomectomy is usually appropriate for patients with reproductive dysfunction and FIGO Type 4 fibroids, preserving the uterus and restoring normal uterine cavity architecture 3
• Hysterectomy provides definitive resolution of all fibroid-related symptoms and accounts for three-quarters of fibroid treatment in the United States 4

Critical Pitfalls to Avoid

• Do not perform endometrial ablation for FIGO Type 4 fibroids, as there is no relevant literature supporting this approach for submucosal fibroids 1