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.

Preparing for a UFE

Which OB/GYNs refer to you for Uterine Fibroid Embolization (UFE)?

I have many OB/GYNs that refer to me. There are some who also don’t understand the procedure. They want to do a hysterectomy, I don’t believe in that, but there’s a large number in my community that understands what this is. It’s the patient’s choice. It’s the least, invasive procedure option for the patient, it cost less to the body as well as resources, and the patient is back home in a day.

Can you help me determine if I am a candidate for UFE and when can we schedule the procedure?

Absolutely, we’ll look at your MRI, ultrasound, all your findings, and make sure you’ve had a pap smear. Based on that we determine that you’re a candidate, and we can schedule you ASAP for the procedure. Like I said, I do the procedure very simply through the wrist so it becomes much, much easier for you.

It’s faster, and a lot of times we do this as an outpatient procedure, so you can go home quicker.

How will I feel throughout a Uterine Fibroid Embolization (UFE) procedure?

During the procedure, we’ll give you sedation, which is basically through a small IV. It makes you feel very comfortable, you may not remember anything from that. We also give you enough pain medicine before, so during the procedure, you probably won’t remember anything. I do it now through the wrist so it’s very minimally invasive, it’s like getting an IV, you won’t realize any of this. 

How will I feel throughout a Uterine Fibroid Embolization (UFE) procedure?

During the procedure, we’ll give you sedation, which is basically through a small IV. It makes you feel very comfortable, you may not remember anything from that. We also give you enough pain medicine before, so during the procedure, you probably won’t remember anything. I do it now through the wrist so it’s very minimally invasive, it’s like getting an IV, you won’t realize any of this. 

Please describe the particles used to block the arteries in a Uterine Fibroid Embolization (UFE).

The particles that we use for the embolization are what I like to describe as little small gelatin balls. They were actually first used in chromatography and they actually are like gelatin, it’s a material that’s really uniform and we go in the range of sizes, 500-700 microns are the ones I use most commonly.

They float in the liquid, the contrast or the saline that we put in, and we can put as many as we want or as little as we want. They are inert so they don’t do anything, they’re not radioactive. They go there and they just block the artery.

How long should I expect to be off work after having a Uterine Fibroid Embolization (UFE) procedure?

It varies by the person, and it varies on how you tolerate pain. I like to explain to my patients there is a difference between pain and suffering. Pain is the physical stimulus like athletes will go through a lot of pain, they are not suffering, they enjoy the sport. Mothers give child birth there’s the physical pain that’s associated but they don’t suffer they want another child. So after we do the procedure, your fibroids are going to scream. It’s going to tell you there’s something not right here and we give you pain medicine, and depending on your response to it, if you manage it well, you’ll be back to work way sooner. A lot of my patients will be working from home, they’ll work off their laptops and things like that.

You’ll have some discomfort doing it but most of my patients are back at work by a week. You compare that to open surgery or myomectomy or one of those things, you spend a lot of time off work and in a lot of pain.

How long should I expect to stay in the facility after having a Uterine Fibroid Embolization (UFE)?

Most of my patients come in in the morning, we do the procedure. We definitely have you stay the night, though I’ve sent patients home the same day, some just want to go home, it all depends on how you tolerate it. We give you some pain medications, if you can tolerate it you can go home the same day, if not the next morning, some like to stay another day or so.

That’s why I also do it from the wrist so when you’re up, when you’re done with the procedure, after two hours, you can do what you want with your hands, and there’s nothing in the areas over your hips, so and sometimes if you’re in pain you may want to curl up, you may want to go the bathroom, whatever you can get up and walk, walking makes you feel better.

So you can be back home soon as the same day, the night or the next day.

What kind of follow-up care is typical after a Uterine Fibroid Embolization (UFE)?

So immediately after your procedure, we want you to come back to the office within a few days to make sure everything is okay. After that, we will follow-up with you periodically to make sure that the fibroid is shrinking and your symptoms have improved. Typically in the first year I do this every three months, we’ll do some MRIs depending on the size of the fibroid, or the number of fibroids you’ve had.

You’ll always have our number you can always reach us at any time.

What happens to the fibroids after a Uterine Fibroid Embolization (UFE)?

So, just like a plant that is not getting any water, it dries up and then shrivels up, we don’t take it out, which with a myomectomy or hysterectomy, the whole garden has been taken out. So I explain to my patients that the uterus is like a garden, every month it prepares to get more plants growing in there.

Will my fibroids or symptoms come back after having a Uterine Fibroid Embolization (UFE)?

It is very, very unusual for your fibroids to come back. Occasionally, the uterus may get blood supply from an ovarian artery or some other artery. I rarely see that, and it’s very easy to do the embolization again if it ever does.

Will I still get my period after having a Uterine Fibroid Embolization (UFE)?

Yes, you’ll have your period after you have a fibroid embolization, usually the first one tends to be a little dry sometimes you may miss it for the first time, and then they come back to a normal period, but I’ve never heard anybody complain about it because they’ve been bleeding for so long and so much and there’s so much pain, and now that they’re not bleeding they’re actually very happy about it.

Can I still get pregnant after having a Uterine Fibroid Embolization (UFE)?

So the procedure of a fibroid embolization is not a procedure that is designed to make you pregnant so it’s not a fertility treatment but if there is a fibroid in the uterus, just like I told you in the garden there’s this big ugly plant sitting right there, a baby cannot grow in the uterus. So, therefore, that causes a miscarriage doesn’t allow the pregnancy to happen, so when we treat the fibroid and it shrinks there’s a chance you are able to get pregnant.

So fibroid embolization is not designed to make you pregnant but if the fibroid was the cause of your not being pregnant and then that cause goes away there is a chance you will be able to get pregnant, so we’ve had patients who get pregnant but I can’t guarantee that there’s no literature suggesting that this will make you pregnant.

How often is Uterine Fibroid Embolization (UFE) successful in treating fibroids?

A high percentage of UFE’s are successful in treating fibroids in patients. Over 95% of procedures are successful. The goal of treatment is to make you feel better, stop the bleeding or the pain, and bring it as close to normal. The goal’s not to take it out completely, and so those goals are met very, very often. We rarely have one that has to be done again, because they’re getting blood supply from somewhere else.

Are your patients happy with the Uterine Fibroid Embolization (UFE) procedure?

My patients are usually very happy with the fibroid procedure. I get hugs from them, their families. It’s a lot of positive energy and it really changes their lives.

What are the typical complications associated with a Uterine Fibroid Embolization (UFE)?

The most common complication is pain, but we’ve learned how to manage the pain, so we work with you as a patient and help you go through it. It’s rare but if somebody doesn’t take the antibiotics they can get a mild infection or even a severe infection, but we make sure we cover them with antibiotics, so in my experience these are all less than 1%, over 200 that I do I may have one that has it. Some get spotting for a while, sometimes the period stops, but then it comes back, but I rarely have anybody complain about that.

Why do you prefer Embosphere® Microspheres for Uterine Fibroid Embolization (UFE) procedures?

I’ve been doing embolizations for over 25 years, and these particles are very uniform. They’re like little small gelatin balls, and we know the exact size that I’m putting it in. So, it’s predictable, it’s easy to mix, there were earlier particles we had to where we had to mix them ourselves try to, formulate them etc.

So it’s easy, it’s quick, it’s safe; don’t get complications with it, it’s cost effective; that works just fine for us.

Am I still a good candidate for a UFE with multiple fibroids?

It all depends on your symptoms, and the fibroids are causing the bleeding. Absolutely, I’ve done it where there have been just almost countless fibroids in the uterus and it’s not a contraindication, we can do that.

Will a Uterine Fibroid Embolization (UFE) be able to treat very large fibroids?

Absolutely yes, can treat very large fibroids, I’ve treated one where the uterus is almost up to the epigastrium, up to the breast bone almost in, looked like a large pregnancy actually, the woman thought she was pregnant first. It takes a little while for the uterus to shrink but yes, it can be done.

Will my insurance cover a Uterine Fibroid Embolization (UFE)?

I know just about every insurance covers uterine fibroid embolization. My office will do all the pre-authorization for you. We call the insurance companies, I’ve never had one procedure declined.

Why would someone need a second Uterine Fibroid Embolization (UFE)?

Very rarely, some patients who have especially large fibroids, can attract blood supply from another spot other than the arteries that feed the uterus the uterine artery. It can come from the ovarian artery or another branch. So if that has been, and that’s not identified under the first time, then you may have to get a second embolization, but again, that is very uncommon, and that’s only if it doesn’t succeed, in fact in the whole fibroid.

When is a myomectomy better than a Uterine Fibroid Embolization (UFE)?

Rarely you may have a fibroid that’s either very large and hanging out of the uterus, what we call an exophytic fibroid and they may not respond well to a uterine fibroid (embolization) and that’s about the only time I have sent somebody for a myomectomy. Most of the times it’s not being a problem to do a fibroid embolization.

What Is adenomyosis? Can it be treated by Uterine Fibroid Embolization (UFE)?

So adenomyosis is a condition of the uterus which again is painful and what you have is some of the endometrial tissue kind of going into the muscle and just like endometriosis is when it’s on the outside so here the endometrium is gone into the muscle a little bit and that causes pain and also the other symptoms that sometimes feels like they are from fibroids.

The issue of whether you can treat it with embolization, it’s been done, it’s been published. People have done it, it’s not a 100% effective but I have personally seen patients where I have treated them and they felt better, it’s better than having a hysterectomy.