In the previous article, we talked about how fast fibroids grow and what size they can reach in some cases. Our focus today is large uterine fibroids. We are going to explore what fibroid size is considered large, what symptoms big fibroids can cause, and what treatment options are effective for large and giant fibroids.
How Big Is a Large Fibroid?
Uterine fibroids are noncancerous tumors that grow in the uterus and depending on their size and/or location might cause a number of symptoms. These benign tumors develop in women of reproductive age and are extremely common. They are particularly common in African-American women and approximately 80% will experience fibroids before they are 50 years old. About 70% of their Caucasian counterparts will also experience fibroids during their lifetime. Uterine fibroids are round and hard as rocks and composed of smooth muscle and fibrous tissue.
Fibroids can range in size from a small bead to as large as a small watermelon. A 6-cm fibroid is considered to be the bottom measurement in the classification of large fibroids.
Although uterine fibroids can reach any size, giant fibroids are rare. The largest fibroid ever documented in a living patient was the size of a pumpkin and weighed over 100 lbs.
Fibroid Size Chart: How Big Do Fibroids Grow?
What Causes A Big Fibroid?
Estrogen plays a key role in the development of uterine fibroids. With estrogen dominance, fibroids tend to grow faster and sometimes, in spurts. Fibroids need a blood supply to thrive and grow so during pregnancy when a woman’s blood supply increases the size of any fibroids present may also increase.
How Do I Know If I Have a Large Fibroid?
Often, women with fibroids are diagnosed during a routine pelvic examination. Large tumors can be more easily identified by an OB-GYN because of their size, shape, and their hardness. To confirm the diagnosis of fibroids, many OB-GYNs use a pelvic ultrasound but the gold standard in diagnosing and examining uterine fibroids is through the use of magnetic resonance imaging (MRI). Along with determining the exact size and position of a big fibroid, this imaging test won’t miss small tumors often not seen on ultrasound images.
What Symptoms Do Big Fibroids Cause?
- Abdominal Pressure – the most common side effect or symptom caused by a massive fibroid is pressure in the abdomen.
- Distorted Uterus – a large fibroid mass can distort the size and shape of the uterus causing a host of other issues. The average size of a uterus is about 3-4” x 2.5” and resembles a pear turned upside down. A huge fibroid can stretch the normal size of the uterus to the same size as a full-term pregnancy.
- Urinary Issues – large fibroids can put pressure on surrounding organs such as the bowels or bladder. Women with large or numerous fibroids often experience urinary incontinence or must make frequent trips to the bathroom during the night.
- Painful Sex – big fibroid tumors fibroids located near the bottom of the uterus can cause pressure on the cervix resulting in painful intercourse, or if located near the top of the uterus can cause abdominal pain during, and even after sex.
- Fertility Issues – a 4cm fibroid or larger that is growing inside the muscle of the uterine wall can inhibit implantation. Large fibroids can also cause a blockage in the fallopian tubes affecting a woman’s fertility and ability to conceive and sometimes even affecting the delivery of the baby.
- Fibroid Weight Gain – fibroids can form in clusters and a big fibroid cluster could grow to be over eight inches in diameter or even bigger – the size of a small watermelon. Large fibroid clusters like this can directly affect a woman’s weight. In a rare case, a woman in Singapore was having difficulty moving around and experiencing breathing problems and doctors removed a giant fibroid weighing 61 pounds from her uterus! Can you imagine a 61-pound fibroid?
- Kidney Damage – a giant fibroid can block the ureter which delivers urine from the kidney to the bladder. This obstruction is called hydronephrosis and requires immediate medical attention to prevent kidney damage.
There are cases when large fibroids remain asymptomatic and the only sign of their presence in the body is a bloated stomach. If this is the case, a female might decide to not undergo any treatment until more significant symptoms occur. This is not advised as big fibroids (fibroids 10 cm or larger) have the potential to rupture or degenerate.
Large Fibroids Can Make You Look Pregnant
When a woman has a large fibroid it takes up considerable space in her uterus. Massive fibroids can expand a normal-sized uterus to a size large enough to make the woman’s abdomen protrude. She may think she has just gained weight and despite her efforts to maintain a healthy diet and exercise routine to address the extra “volume” in her lower abdomen, the volume remains.
In the medical community, it is common to compare the size of a uterus with fibroids to the size of the uterus during pregnancy (the size measurement only). The abdomen of a woman with a 10 cm fibroid growing in her uterus resembles a woman in her 14th-16th week of pregnancy.
How Big Can a Fibroid Grow Before It Becomes Dangerous?
Many people wonder which size of fibroid is dangerous, and the answer may surprise you. It is true that fibroids that grow large are most often the cause of common fibroid symptoms; however, the size of a uterine fibroid alone is not the sole determinant of whether it is considered dangerous.
While larger fibroids, typically those larger than 8 cm in diameter, may be associated with increased risks and complications, it’s important to note that the danger of a fibroid depends on various factors, including its location, symptoms, and impact on the patient’s overall health.
For example, a small fibroid that is located in a critical area of the uterus, such as near the cervix or fallopian tubes, may still cause significant symptoms or complications despite its small size. On the other hand, a large fibroid that is located away from critical structures and is not causing any symptoms may not be considered dangerous.
Another rare but dangerous complication that can occur with fibroids is called degeneration, which can be caused for emergency medical assistance. Studies have shown that this can occur in fibroids that are 5 centimeters in diameter and not particularly large in size.
The specific risks and complications associated with uterine fibroids can vary widely from person to person, and the size of a uterine fibroid alone is not the sole determinant of whether it is considered dangerous.
What Size Fibroids Need Surgery?
If you have fibroids that are causing painful symptoms or impeding your ability to function in your daily life, it is time to eliminate them. Fibroids can be big or small and they can grow bunched together in clusters. Their location can sometimes be more problematic than their size but most often it is the larger fibroids that cause problems.
Patients often ask “what size fibroid is dangerous” and this is a bit tricky to answer because sometimes it is both the size and location that create the potential for more serious complications. Huge fibroids can distort the shape of the uterus and cause fertility issues, they can crowd other internal organs, press on nerves, and cause back and leg pain or frequent urination. Large or numerous fibroids located inside the uterus can cause heavy and prolonged bleeding.
The larger fibroids grow, the more chance that they can degenerate and potentially rupture. Fibroids that have grown to at least 5-8 cm have this potential. A single small fibroid may not cause significant symptoms, but many small fibroids can create the same symptoms as a single large fibroid. As fibroids continue to grow in size and number, the potential for them to cause symptoms and complications grows as well. If you have fibroids that are increasing in size, the uterine fibroid embolization procedure can kill fibroids, eliminating symptoms by forcing them to shrink dramatically in size and preventing them from growing any larger.
It may be time to consider uterine fibroid embolization if you want to avoid some of the painful symptoms that can arise with larger fibroids. You may also want to seek out treatment if you’re already suffering from some of these symptoms and are seeking relief. One fibroid type is submucosal fibroids, and they develop on the inside of the uterus. When left to grow, these fibroids can eventually begin to misshape the lining of the uterus. This may increase the risk of reproductive issues down the line.
The larger a fibroid is allowed to grow, the more difficult treatment can become. To make treatment as simple and comfortable as possible, you may want to consider treating your symptomatic fibroids before they reach the size of a grapefruit.
Another reason to seek out treatment before the fibroid gets large is there can be a rare association between large fibroids, and blood clots developing in the lungs.
What Size Fibroids Should Be Removed?
Through the use of a 3D MRI image, the size, shape, and position of uterine fibroids can be accurately diagnosed.
As a general rule, most doctors will recommend “watchful waiting” for 4-cm fibroids or smaller ones. For 5 cm fibroids or larger a course of action is normally recommended because of the fibroid’s potential to grow and cause symptoms.
How Are Large Fibroids Removed?
When a woman is diagnosed with fibroids she is often told by her OB-GYN that the only form of treatment for her is surgery to either cut the fibroids out (myomectomy) or remove her uterus altogether (hysterectomy).
Most myomectomies and hysterectomies are performed laparoscopically these days through 5 or 6 small incisions placed in the abdomen. Most experts agree that laparoscopic surgery is not ideal to remove massive fibroids (fibroids over 5” in diameter or 9-10 cm fibroids) which could result in an open myomectomy or hysterectomy significantly increasing the risks and potential for complications.
During a myomectomy, the surgeon cuts each fibroid out of the uterus individually and removes them through a small abdominal incision. If the fibroid will not fit through the incision, it must be dissected into small pieces before being removed.
The location, number, and size of the fibroids often affect the surgeon’s ability to adequately remove them all and 50% of women experience fibroid recurrence and require another procedure within 5 years. The fibroids left behind or only partially removed grow about 11% each year.
Another risk related to the myomectomy procedure is that it can result in a “last-minute” hysterectomy. All women who undergo a myomectomy must sign a waiver stating that if the doctor feels it necessary during the myomectomy they may change the surgery to a hysterectomy. This risk is elevated for women with big fibroids.
During a hysterectomy, the woman’s uterus is removed. Sometimes this includes the cervix, one or both ovaries, and/or fallopian tubes. Removal of the uterus would put an end to the woman’s suffering from fibroid symptoms but could also begin a number of other undesirable side effects.
In addition to eliminating the possibility of becoming pregnant, removing the uterus can cause the onset of early menopause, sexual dysfunction, ovarian failure, urinary incontinence, bone loss, increased risk of heart disease and stroke, etc.
Does UFE Work for Large Fibroids?
Yes! Uterine fibroid embolization (UFE) is the best treatment for large fibroids and does not require surgery.
Uterine Fibroid Embolization For Large Fibroids
Unlike myomectomy, UFE treats all fibroids regardless of their number and size, and sometimes, UFE is the only option for a woman with a large tumor.
UFE works because it cuts off the blood supply that the fibroid tumors need to stay alive. When their blood supply is cut off they start to shrink and die. This brings women with massive fibroids, even 10 cm fibroids, significant relief from their symptoms.
Uterine fibroid embolization is a quick 45-minute outpatient procedure so it does not require a hospital stay and patients are discharged to recover at home with only a small bandaid. Most patients recover in only a week and many experience relief in a matter of days or elimination of symptoms by 3 months post-procedure.
If you suspect that you have large fibroids, and would like another option besides surgery, please schedule a consultation with one of the leading fibroid experts Dr. John Lipman by calling (770) 953-2600 or by booking an appointment online at Atlanta Fibroid Centerr®.