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 large 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.
Fibroid Size Chart: How Big Do Fibroids Grow?
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.
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.
Large Fibroids Can Make You Look Pregnant
When a woman has a large fibroid it takes up considerable space in her uterus. Large fibroids can expand a normal size 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 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 large 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 large 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 large 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 very large 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 large fibroids (fibroids 10 cm or larger) have the potential to rupture or degenerate.
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 5cm 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 larger 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 large 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, increase 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 large fibroids, even 10cm 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®.