Fibroids are non-cancerous tumours that can develop in the uterus of women during their reproductive years. They are relatively common, with many women experiencing fibroid growth at some point in their lives. While most fibroids do not pose a significant health risk, there are certain sizes that can be considered more dangerous than others. The size of a fibroid is an important factor in determining its potential impact on a woman’s health and well-being. In this article, we will explore the significance of fibroid size and discuss the potential risks associated with larger fibroids. Understanding the implications of fibroid size can help individuals make informed decisions regarding their treatment options and overall reproductive health.

Which size of fibroid is dangerous?

The maximum size of a fibroid that can be considered dangerous can vary depending on various factors, including its location, growth rate, and symptoms it causes. Generally, fibroids larger than 5 centimeters (about 2 inches) in diameter are often considered significant and may lead to more noticeable symptoms and potential complications. However, it’s important to note that the size alone does not determine the severity of the fibroid’s impact. Other factors, such as the location of the fibroid and its effect on nearby organs, can also play a role in determining its potential risks. If you suspect you have a large fibroid or are experiencing concerning symptoms, it is recommended to consult with a healthcare professional for a proper evaluation and personalised advice.

Can large fibroids cause complications during pregnancy?

large fibroids can potentially cause complications during pregnancy. The impact of fibroids on pregnancy can vary depending on factors such as the size, number, and location of the fibroids. Some potential complications associated with large fibroids during pregnancy include:

  • Increased risk of miscarriage 
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Large fibroids may interfere with the implantation of the embryo or placenta, increasing the risk of miscarriage.

  • Preterm labour 

Fibroids can disrupt the normal functioning of the uterus, potentially leading to preterm labour or premature birth.

  • Placental abruption 

In some cases, fibroids may cause the placenta to separate from the uterine wall before delivery, resulting in a potentially life-threatening condition known as placental abruption.

  • Fetal growth restriction 

Large fibroids may restrict the space available for the growing fetus, leading to poor fetal growth and development.

  • Malpresentation

Fibroids can obstruct the baby’s passage through the birth canal, causing abnormal fetal positioning and potentially necessitating a cesarean section.

  • Increased risk of caesarean section

Depending on the size and location of the fibroids, vaginal delivery may not be possible or may pose risks to both the mother and the baby, requiring a caesarean section.

What are the symptoms of a large fibroid?

The symptoms can vary depending on the location, size, and number of fibroids. Some common symptoms associated with large fibroids include:

Heavy or prolonged menstrual bleeding 

Large fibroids can cause heavy or prolonged menstrual periods, often accompanied by clotting. This can lead to anaemia or fatigue.

Pelvic pain or pressure 

As fibroids grow, they can exert pressure on surrounding organs, such as the bladder or rectum, causing pelvic pain, discomfort, or a feeling of fullness.

Frequent urination

Fibroids pressing against the bladder can lead to increased frequency of urination or a constant urge to urinate.

Difficulty with bowel movements

Fibroids that press against the rectum can result in constipation or difficulty passing stools.

Abdominal enlargement

In some cases, large fibroids can cause the abdomen to appear enlarged or distended, leading to a noticeable increase in waist size.

Back or leg pain 

Fibroids can sometimes cause pain radiating to the lower back or down the legs.

Painful intercourse 

Fibroids located near the cervix or within the uterine cavity can cause pain or discomfort during sexual intercourse.

Infertility or recurrent miscarriages 

Depending on their size and location, large fibroids can interfere with fertility by blocking the fallopian tubes or affecting the implantation of a fertilised egg. They may also increase the risk of miscarriages.

How are large fibroids diagnosed?

The diagnosis of large fibroids typically involves a comprehensive approach that includes a thorough medical history review, a physical examination, and various imaging tests. The healthcare professional will begin by gathering information about the patient’s symptoms, menstrual history, and relevant medical background. They will then conduct a pelvic examination, feeling for any irregularities or enlarged areas in the uterus. 

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To further confirm the presence of fibroids and assess their characteristics, imaging tests such as ultrasound are commonly used. Ultrasound can provide a visual representation of the uterus, allowing the healthcare provider to determine the size, number, and location of the fibroids. These diagnostic measures enable healthcare professionals to accurately identify large fibroids and develop appropriate treatment plans tailored to the individual needs of the patient.

What are the Treatment options for large fibroids?

Here are some common treatment approaches for large fibroids:

Watchful waiting 

If the fibroids are not causing significant symptoms or complications, and the patient is not planning to conceive in the future, a “watchful waiting” approach may be recommended. Regular monitoring and observation of the fibroids’ growth and symptoms are conducted without immediate intervention.

Medications

Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or hormonal therapies like birth control pills or gonadotropin-releasing hormone (GnRH) agonists may be prescribed to alleviate symptoms such as heavy bleeding, pelvic pain, or pressure. These medications do not eliminate the fibroids but can help manage symptoms temporarily.

Minimally invasive procedures

There are several minimally invasive procedures available to treat large fibroids while preserving the uterus. These include:

  1. Uterine artery embolization (UAE): This procedure involves blocking the blood supply to the fibroids, causing them to shrink over time.
  2. Magnetic resonance-guided focused ultrasound surgery (MRgFUS): This non-invasive procedure uses high-intensity ultrasound waves to destroy the fibroids.
  3. Laparoscopic or robotic-assisted myomectomy: In this surgical procedure, the fibroids are removed while preserving the healthy uterine tissue.

Hysterectomy

In cases where symptoms are severe, fertility is not a concern, or other treatments have been ineffective, a hysterectomy may be recommended. This surgical procedure involves the removal of the uterus and is considered a definitive treatment for fibroids.

What are the potential risks of leaving large fibroids untreated?

Leaving large fibroids untreated can potentially pose certain risks and complications. While not all fibroids require immediate treatment, it is essential to consider the potential consequences of untreated large fibroids. Here are some potential risks: 

  • Worsening symptoms
  • Increased pain or discomfort
  • Heavy menstrual bleeding
  • Anemia
  • Decreased quality of life
  • Impact on daily activities
  • Urinary issues
  • Bowel problems
  • Infertility or pregnancy complications
  • Difficulty conceiving
  • Increased risk of miscarriage
  • Preterm labour or premature birth
  • Placental abruption
  • Malpresentation of the fetus
  • Increased likelihood of cesarean section
  • Psychological distress

FAQ

Q1: Can large fibroids shrink on their own?

Ans: Large fibroids may shrink with menopause or hormonal changes, but not always.

Q2: Can large fibroids turn into cancer?

Ans: Large fibroids are typically benign and rarely turn into cancer.

Q3: Can large fibroids cause weight gain?

Ans: Large fibroids can cause a swollen abdomen, which may be mistaken for weight gain.

Q4: Can large fibroids affect bladder function?

Ans: Large fibroids can exert pressure on the bladder, leading to urinary frequency or urgency.

Q5: Can large fibroids cause back pain?

Ans: Large fibroids pressing on surrounding structures can cause back pain.