Abnormal uterine bleeding (AUB) represents the most common indication for hysteroscopic myomectomy. In fact, submucosal myomas are associated with abnormal uterine bleeding more than intramural and subserosal fibroids, presumably due to the distortion of the cavity and an increase in the bleeding surface of the endometrium.
Although most women affected with fibroids are fertile, the available evidence suggests that fibroids can interfere with fertility, and submucosal fibroids are reported to exert the most detrimental effects on pregnancy rates. Reproductive problems represent the second main indication for hysteroscopic myomectomy, although the lack of randomized studies does not allow to draw definitive conclusions on the improvement of spontaneous fertility after hysteroscopic myomectomy.
Less frequent reported indications include dysmenorrhea, nonspecific pelvic pain, and asymptomatic submucosal fibroids in postmenopausal females prior to initiate hormone replacement therapy.