A 30-year-old woman with a solitary 3 cm submucosal fibroid causing menorrhagia is planned for hysteroscopic resection. On saline infusion sonography the fibroid extends into the myometrium such that less than half of its circumference is surrounded by endometrium. According to the ESHRE/ESGE classification it is:

• A Type 0 (pedunculated, intracavitary)
• B Type III (purely intramural touching the endometrium)
• C Type II (submucosal with 50% or more intramural extension)
• D Type I (submucosal with less than 50% intramural extension) ✓

Explanation

The ESHRE/ESGE system grades submucosal fibroids by intramural extension: Type 0 is entirely intracavitary, Type I has less than 50% myometrial extension, and Type II has 50% or more. A fibroid with less than half its circumference embedded in myometrium is Type I and remains amenable to one-step hysteroscopic resection. Type II often needs staged resection or adjunct techniques. Type III is purely intramural and not hysteroscopically accessible.

Reference: Jeffcoate's Principles of Gynaecology, 8th ed.

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