These are external to the uterine muscle and are connected by a thin stalk. They are the least likely to be symptomatic and rarely need removal. Rarely there is liquifaction and bleeding within the center causing pain and fever. Infection may also occur. The most common occurrence is during pregnancy.
Treatment is never surgery but conservative with fluids, pain medication and antibiotics.
Large intramural fibroids may be the cause of longstanding infertility if all other causes have been excluded. Busarelin are medications given by injection or nasal spray that create a temporary menopause allowing shrinkage. However on stopping medication the fibroid regrows to its original size. Therefore longterm treatment is not indicated as these drugs cause severe menopausal symptoms and osteoporosis. They are used for 1-3 months before surgery to reduce the blood loss of surgery.