How Large Can Fibroids Grow?

Uterine fibroids vary widely in size from as small as a coin to the size of a large melon. A very large uterine fibroid can cause the uterus to expand to the size of a 6 or 7-month pregnancy. Fibroids can form as one single dominant fibroid or as a cluster of many small fibroids.

A woman’s uterus is approximately 3 inches (7.6 cm) long and pear-shaped. A small fibroid may not cause any symptoms, so you may not even know you have it. A larger fibroid may cause your uterus to enlarge, and then you will start to notice changes.

Can fibroids be seen on Ultrasound?

Using sound waves with frequencies (pitch) much higher than audible sound, ultrasound is the most commonly used type of scan for pelvic evaluation. The ultrasound probe can be placed on the abdomen or it can be placed inside the vagina to help scan the uterus and ovaries. It is quick and simple and generally accurate. However, it relies on the experience and skill of the person performing the scan to produce good results and may not always demonstrate larger fibroids or other conditions such as adenomyosis.

Is a hysterectomy necessary to treat fibroids?

My opinion, no. You don’t need a hysterectomy. I speak to a lot of women in many different communities, and even to men and couples. If a man had a little benign tumor in his testicle, and he was told he’s going to have his testicles cut off, he would absolutely not want it. Women are told that all the time for a benign condition to take the uterus out.

I’ve had women being told, why do you need it. I think it’s absolutely unnecessary for those.

Does size and number of fibroids matter?

For the procedure, it doesn’t, but for a patient, it might. If you have two very small ones you may not have many symptoms and you happen to have an ultrasound and you find it, but it’s not bothering you, then you don’t treat it. But, if you have many fibroids or very large ones and they cause you problems, then you might want to treat them, but all of these can be treated with fibroid embolization.

Please explain how you would coordinate care with my OB/GYN.

So assuming you’ve already seen an OB-GYN, or if you don’t already have one, I’ll help you find one, I work with many. We’ll get all the information from the OB-GYN, we’ll see how the diagnosis was made, confirm that this is a fibroid and that your symptoms are coming from the fibroid. We’ll make sure they’ve done a pap smear and endometrial biopsy and there’s nothing else going on. Once we’ve taken care of the fibroid, we’ll make sure they get the information and get you back so you have continuity of care.

Is it always necessary to treat fibroids?

The answer is if somebody has a small fibroid or even a slightly large fibroid but they’re totally asymptomatic and it doesn’t bother them, then you don’t treat it. So I always teach, I’ve taught countless fellows, residents, and students, you treat the patient, not the film or the finding on the ultrasound or x-ray. So if the patient is symptomatic, and you’ve got pain,  bleeding, and other problems associated with the fibroid, then you should probably treat the fibroid.

Are there medications or natural remedies used to treat fibroid symptoms?

As you can tell I’m from the east, I’m from India, I believe in Ayurveda as well in a holistic approach. So I try to take a holistic approach to this, the mind the body, everything comes from nature, so they are some natural remedies, but they’re not really remedies, they don’t cure the fibroids, the fibroids don’t disappear.

Some of these may help you feel better but I’ve never seen one of this things completely take care of a fibroid.

How can fibroids affect sexual intercourse?

So one of the things that happens is if the fibroid is big or it’s low down, it can become very painful during intercourse, which is called dyspareunia. Once the fibroid is treated and starts to shrink down, then that pain goes away. Also, if a woman is bleeding for three weeks out of a month it’s very hard to have sexual intercourse. 

How is an enlarged uterus from fibroids like pregnancy?

Well, if you look at a pregnancy the uterus is like a little sack and there’s a baby growing in it. From the outside we just see the sack is big, a fibroid is in the muscle of the uterus, and it’s not supposed to be there but it’s still a mass. When you feel it from the outside, it feels like a pregnancy.

It’s not a pregnancy, but it feels like a pregnancy. And the way we measure pregnancy is by how big the uterus is and so to some women they think they’re pregnant but then they bleed and then they realize something is not right. And that’s how we kind of compare that to pregnancy in terms of size but there’s no other comparison.

Can fibroids grow during pregnancy?

Yes, during pregnancy there a lot of hormones that are being produced by the body for the baby to grow, and at that time the fibroids can get larger because they’re just getting more jolt if you would.

Will my fibroids still be a problem after menopause?

Not necessarily, your fibroids won’t be a problem after menopause, but if you are taking hormonal supplements, then there is the estrogen that feeds that the fibroid and that potentially can get the fibroid to grow. So it’s the hormones that make the fibroid go. So if you are not on any replacement, then it’s unusual to have fibroids be a problem after menopause.

In fact a lot of the gynecologists would say if you’re very close to menopause do not do anything so that when you reach menopause, there are no hormones, so it will settle down and you won’t have a period, but that’s not always true these days, there’s a lot of replacements and other things that come into play.

What is a myomectomy? What are the challenges with a myomectomy?

One of the procedures, which is a surgical procedure, is where you have to be cut open and look inside, is the removal of the fibroids. So the fibroid is called leiomyoma, is a smooth muscle tumor, and removal is an ectomy. So myomectomy is where they actually surgically go and cut it out. It’s an open procedure, you will need anesthesia. There are many complications associated with that.

These days they also have a robotic option which is very expensive. I’ve had patients tell me can go up to $100,000, the machine is very expensive. Fibroid embolization is a very inexpensive option to it. It’s simple you’re home the same day. So myomectomy sometimes is necessary, but not always.

What is more common, the open myomectomy or the laparoscopic myomectomy?

It really depends on what surgeon or gynecologist is doing the surgery. I have seen them do both being done depending on the older surgeons who will tend to open and the younger ones who had laparoscopic training tend to do more laparoscopic but if it’s not needed, it’s not needed, whichever one you do it with.