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Fibroid Size and How It Impacts the Treatment - An Overview

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Fibroids are noncancerous growths in the uterus. This article explains dangerous fibroids' type and size, impact, and treatment.

Written by

Dr. Asha. C

Medically reviewed by

Dr. Priyadarshini Tripathy

Published At November 15, 2022
Reviewed AtNovember 15, 2022

What Is a Fibroid?

Uterine fibroids are noncancerous growth made up of the muscle and connective tissue from the uterus wall. It often appears during childbearing years, called leiomyomas or myomas. Uterine fibroids are not associated with an increased risk of uterine cancer and rarely develop into cancer. Fibroids range in size from 1 mm, undetectable by the human eye, to bulky masses more than 20 cm in diameter that can distort and enlarge the uterus. Fibroids can grow as a single nodule or cluster. Fibroids can develop within the uterus wall, inside the uterus's cavity, or on the outer surface of the uterus.

What Are the Types of Fibroids?

Uterine fibroids are noncancerous growths, and there are four types :

  • Intramural Fibroids - It is the most common type and grows in the uterus wall.

  • Subserosal Fibroids - These types of fibroids grow on the outside of the uterine wall. When they grow larger, they cause pressure on nearby organs or pain due to their size.

  • Submucosal Fibroids - These are the rarest type of fibroids. These types of fibroids grow just below the uterine lining, which can lead to heavy bleeding and other more serious complications.

  • Pedunculated Fibroids - These fibroids grow on small stalks or stems and can grow both outside the uterus and inside the uterine cavity.

About 70 to 80 percent of women develop fibroid by the time they reach the age of 50. Women can also develop more than one type of fibroid.

How Does the Fibroid Grow?

Fibroids grow from a single cell that continues to multiply and expand. Normally, fibroids grow in size as long as there is blood and a hormone supply, especially estrogen. Many women experience fast growth of fibroids during perimenopause due to a temporary increase in female hormones.

Which Size of Fibroids Are Dangerous?

Fibroids are not usually life-threatening, although they can cause major problems. Smaller fibroids usually do not cause any problems or symptoms. Medium or large-sized fibroids can cause many problems, like pressing on the bladder and bowel, which can cause frequent urination or constipation. Larger fibroids mostly cause more discomfort and pain as they grow and put pressure on other parts of the body.

Does the Size of the Fibroid Matter?

The size of the fibroid is a pivotal factor regarding whether or not to seek treatment. Even though large fibroids are more likely to press on other organs and create pain, discomfort, and excessive bleeding, this is not always the case. Because some women with large fibroids experience no symptoms, in some cases, these are discovered only during a routine pelvic examination. On the other hand, few women have tiny fibroids that create several symptoms that interfere with daily activities because of their position. Therefore, treatment for uterine fibroid depends upon the symptoms they cause rather than on their size.

Is There Any Size Chart to Measure the Size of Fibroids?

A reference chart is available for ease of classification and quick reference.

  • Small Fibroid - Fibroid less than 1 cm to 5 cm in length (size of a pea to a cherry)

  • Medium Fibroid - Fibroid that is five cm to 10 cm (the size of a peach to a large orange)

  • Large Fibroid - Fibroids that are ten cm or more (the size of grapefruit to a small watermelon)

Besides being uncomfortable, Larger fibroids do not cause any problems, and smaller fibroid does not always confirm that there is nothing to worry about.

What Are the Impacts of Large Fibroids?

As the size of fibroids increases, their impact on the body becomes more significant. Large fibroids take up space for other organs and cause pain and discomfort. Below are the effects that can arise when fibroids grow in size.

  • Impacting the Uterine Lining - Fibroids found inside the uterus may change the shape of the uterine lining. If it is not removed, fibroids can impact the ability to become or stay pregnant.

  • Discomfort and Pain in the Pelvis and Lower Back - Due to their large size and weight, fibroids put excessive pressure on the pelvis region, which can cause pain and discomfort in the pelvis and lower back.

  • Uterine Damage - If the fibroids are larger than a three-month-old fetus, they cause damage to the uterus during surgical removal, so they should be treated before becoming large.

  • Increased Urination - If the fibroid is very large, it puts pressure on the urinary bladder, leading to frequent urination.

  • Ruptures - There are chances for rupture of very large fibroids inside the uterus that can cause sudden and extreme pain.

  • Blood Clots - In extremely rare instances, very large fibroids can cause the development of a pulmonary embolism (blood clot in the lung). It can be a potentially fatal complication.

What Is the Treatment for Uterine Fibroid?

Treatment for uterine fibroids will vary depending on the size, number, and location of the fibroids and the symptoms caused by fibroids. If fibroid does not cause any symptoms, treatment may not be required. Small fibroids can often be left untreated if it does not cause any symptoms. Some women do not experience any symptoms or problems associated with fibroids. In such cases, fibroids will be monitored closely over time, but there is no need to take immediate action. If fibroids cause any discomfort, treatment is usually required.

The treatment plan will depend on a few factors, including:

  • The number of fibroids.

  • Size of fibroid.

  • Location of fibroid.

  • Any symptoms related to the fibroids.

  • A desire for pregnancy.

  • A desire for uterine preservation.

1. Medications:

  • Over-The-Counter (OTC) Pain Medications - Medications like Acetaminophen and Ibuprofen manage discomfort and pain caused by fibroids.

  • Iron Supplements - Iron supplements are required if there is anemia from excess bleeding.

  • Birth Control - Birth control pills can control heavy bleeding during and between periods and menstrual cramps.

  • Gonadotropin-Releasing Hormone (GnRH) Agonists - These temporary medications help shrink fibroids. Sometimes, it is used to shrink a fibroid before surgery, making removing the fibroid easier.

2. Fibroid Surgery:

There are several factors to consider during the surgical removal of the fibroid. Not only can the size, number, and location of fibroids influence the type of surgery, but plans for pregnancies can also be an important factor when planning treatment. There are options to preserve the uterus and allow for becoming pregnant in the future, while other options can cause either damage or remove the uterus.

Myomectomy is a procedure to remove fibroids without damaging the uterus. There are different types of myomectomy, and healthcare professionals choose the procedure for the patient depending on factors like location, size, and the number of fibroids. The different types of procedures to remove fibroid include:

  • Hysteroscopy - Fibroids are removed using a device called a scope (a thin, flexible tube-like tool). No incisions are made during this procedure.

  • Laparoscopy - Using a scope to remove the fibroids, but unlike hysteroscopy, this procedure involves placing a few small incisions in the abdomen.

  • Laparotomy - Fibroids are removed through one larger cut made in the abdomen. If a woman is not planning for future pregnancies, there are surgical approaches that remove the uterus. These surgeries are effective, but they prevent future pregnancies. Surgeries to remove fibroids can include:

  • Hysterectomy - During this surgery, the uterus is removed. By removing the uterus completely, the fibroids can not come back.

  • Uterine Fibroid Embolization - This procedure blocks the blood flow from the uterine artery to the fibroids, leading to fibroid shrinkage due to loss of blood flow.

Conclusion:

Uterine fibroids are noncancerous growth in the uterus. They may or may not cause symptoms. The fibroid size is not a factor to be considered, but if a woman has any pain or discomfort due to the fibroid, then treatment is required. Different treatment types depend on the size, location, and several fibroids. Consult a doctor if you have any symptoms.

Frequently Asked Questions

1.

Fibroids Become Problematic After What Size?

A large fibroid can become problematic. A fibroid larger than 4 cm or bigger may cause various other problems, such as fallopian tube blockage. This could lead to infertility. This could lead to severe pain and the need for surgery. 

2.

Fibroids of Which Size Require Surgery?

Fibroids over 3 cm in diameter can cause significant symptoms such as pain and infertility. Such types of fibroids may require surgery for their treatment. This procedure is known as a myomectomy. 

3.

What Are the Various Treatment Options Available for Fibroids?

The various treatment options that are available for fibroids include the following: 
- Uterine artery embolization.
- Laparoscopic treatment. 
- Endometrial ablation. 
- Hysteroscopic myomectomy. 

4.

What Are the Effects of Fibroids on the Body?

The effects of fibroids on the body include:
- Heavy bleeding during menstruation. 
- Extremely painful menstruation. 
- Pressure in the lower abdomen. 
- Frequent urge to pass urine.
- Constipation.
- Bloating of the abdomen. 

5.

What Are the Effects of Untreated Fibroids?

Fibroids, when left untreated, can continue to grow in size. There will be continued heavy bleeding during menstruation. This will also be associated with severe abdominal cramping. Excessive bleeding could also result in anemia. 

6.

Is There Any Alternative to Surgery for Fibroids?

Yes, fibroids that are smaller in size can be cured by alternate treatments. A procedure called Uterine artery embolization can be performed to reduce the size of the fibroids. In this case, the blood supply to the fibroid is cut off, causing the growth to shrink. 

7.

Do All Fibroids Need Treatment?

All fibroids do not need treatment. Fibroids that are smaller and have few symptoms can be managed without treatment. It is generally observed that fibroids resolve on their own after menopause. 

8.

Can Fibroids Resolve on Their Own?

Yes, it has been observed that fibroids resolve spontaneously without any treatment. But if the symptoms are severe, the doctor will suggest appropriate treatment. The treatment can range from medications to surgery. 

9.

Can Fibroids Increase With Age?

Yes, fibroids are more common in women over the age of 30. Fibroids tend to shrink on their own after menopause. This is due to the decrease in the circulation of estrogen. The age of onset of fibroids is genetically determined. 

10.

Can Fibroids Cause Weight Gain?

Fibroids do not cause weight gain directly. If the fibroids are very big, it can cause the affected person to gain a few kilograms. However, fibroids can appear as bloating in the belly and heaviness in the lower abdomen. 
Dr. Priyadarshini Tripathy
Dr. Priyadarshini Tripathy

Obstetrics and Gynecology

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