The Fibroid Growth Study: Determinants of Therapeutic Intervention.
Authors: Davis BJ, Haneke KE, Miner K, Kowalik A, Barrett JC, Peddada S, Baird DD. J
Journal: Women’s Health (Larchmt). 2009 May;18(5):725-32.
Study performed by: National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA. Barbara.Davis@MPI.com
Problem: A common question in my office is “if these fibroids grow, won’t I just need treatment in the future?” Despite years of studies about fibroids, no one has ever documented if there is a size at which women will always want treatment.
Study: MRIs were done on 116 premenopausal women, ranging in age from 20 to 54 years; 48% were black women, 41% were white women, 10% were women of other racial backgrounds
Conclusions: Neither the number of fibroids a woman had nor the over-all size of her uterus was related to which women chose treatment. The women who asked for treatment had more symptoms, including more bleeding and pain, compared with the women who chose not to have any treatment. The authors suggested that aggressive treatment of pain and bleeding might reduce the need for surgery.
Dr. Parker’s Comment: The size of a woman’s fibroid does not always correspond with the degree of her symptoms. For instance, a small fibroid (even 2-3 cm = 1 inch) inside the uterine cavity can cause severe bleeding and anemia. But, a large fibroid, say 7 cm (3 in), outside the uterine wall will cause no extra bleeding. A 7 cm fibroid sitting directly over the bladder can cause urinary frequency and the need to get up in the middle of the night to urinate, very bothersome symptoms to some women. But, a 7 cm fibroid at the top of the uterus may cause a little bloating, but not enough for the woman to seek treatment. So, sizes, number and position of the fibroids are all important factors in determining which women might have bothersome symptoms.
34 Comments
I have three large fibroids 9cm, 5cm and 3cm. I am 43 yrs old and would like to have a baby. My periods are regular, with not much pain. My stomach feels bloated all the time and sometimes I pee a lot. My legs hurts at the back, especially in the morning. Please advise me as to what I should do. I am scared of surgery because I don’t have any children.
Terry,
The only fibroids that decrease fertility are those that bulge inside the uterus. The best ways to tell this are either an MRI or a sonogram with saline inserted into the uterus. If there are no fibriods bulging inside the uterus, then surgery would not be helpful. If there are fibroids bulging inside, then surgery would help you to be as fertile as a 43 year old woman without fibroids.
It is likely that fibroids this size could cause pressure on the bladder and make you need to urinate more often. It is less likely that they are causing you leg pain.
To read more about this, see this link: http://www.fibroidsecondopinion.com/fibroids-and-pregnancy/
Bill Parker, MD
Hi Dr Parker,
I am 44yrs old with one son 5.5yrs old. I was diagnosed with a mild bicornuate uterus with 3fibroids under 1.8cm when I was pregnant. I had a very good pregnancy with only one bout of preterm labor at 28wks, which was controlled with albuterol. The last 3yrs I have had some mild symptoms where my chest is very very sore, severe bloating and I would go without a period for anywhere from 40-51dys. This happened about once a year.
Then last August while on vacation, I had the heaviest most awful period Ive ever had for about 5 days and then it tapered off. I’m guessing I passed a lot of clots as well. After all that, I went without a period for 51 days and in that time period I requested a ultrasound from my ob/gyn. The result came back that now I have 4 fibroids, one of them grew to 2.3 cm and the new one is a submucosal (causing the bleeding etc most likely).
My Dr gave me the typical options. 1.Hysterectomy, 2. Lupron, 3. Myomectomy and 4. ablation. He suggested with my condition, the Hysterectomy. We wanted to try one last time for a child. I am swaying towards the lupron but understand its only a temp fix. In the meantime I am constantly bleeding and passing some clots. I am taking ibuprofin and a multivitamin w/iron due to this. I am awaiting results from my ob/gyn for hormone blood levels. The RN in the office today said from what she could see, all levels came back in the normal area (for my age?) but that the Dr hadnt seen them yet. This is what I would understand help to see if I should even bother going the route of lupron or not. I was also advised by another online Dr that a laparoscopic myomectomy and UAE are still options. With all this, what is your opinion?
AB,
If you are even considering more children then hysterectomy and UAE should not be options. If a fibroid is submucosal, it often can be removed hysteroscopically – through the cervix without any incisions. This should decrease bleeding and improve your fertility.
If the fibroid cannot be removed hysteroscopically, then abdominal myomectomy or laparoscopic myomectomy should be considered. These procedures will preserve fertility and removing the fibroids will decrease bleeding.
Bill Parker, MD
Hi,
I have a submucosal fibroid of 3 cm. My doctor wants me to take Lupron for 2 months to shrink my fibroid before she does a laparoscopy and hysteroscopy . After reading all the negative effects of Lupron, I was wondering if she would be able to do the surgery without me taking the Lupron. She believes that my fibroid is too large. 3 cm doesn’t sound that big to me! What is your opinion?
Chantal,
Although it depends on how much of the fibroid is in the uterine wall, I agree with you – a 3 cm fibroid should not be too large to remove hysteroscopically in the hands of a skilled hysteroscopic surgeon. Also, if this is the only fibroid, and there is no other good reason to do a laparoscopy, that should not be necessary either. You might get another opinion from someone who does a lot of hysteroscopic surgery to see what they think.
Bill Parker, MD
I am 40 years old, and until this year had never concieved. I became pregnant and was told I had 2 large fibroids inside my uterus.
I got to 25 weeks pregnant but sadly my waters broke and I got an infection in my uterus, which caused my baby to die inside me. I then had to go through the process of labour, which was horific!
I have now been told to have my fibroids removed by cutting into my abdomen, I do not know what to do.
Was it definitely the fibroids which caused early labour?
Please help me to decide.
Christina
Christina,
I am very sorry to hear about your loss. Fibroids should not cause the water to break, or cause an infection. Infections can occur during pregnancy, with or without fibroids, and the infection leads to the water breaking, but we often do not know what caused the infection. Fibroids inside the uterus can cause infertility or very early miscarriage, before 12 weeks, but this would be a very unlikely cause of problems at 26 weeks. You should carefully go over these issues with your doctor so that you are clear about what they are recommending and why. You might also consider getting a second opinion from a high-risk pregnancy doctor (perinatologist).
Bill Parker, MD
I am 43 yrs old and have been dealing with pain in my pelvic, burning feeling below my belly button,before and 2wks after my period i begin hurting in the lower extremeties. I have missed 1 period and am very consitent with my period. I have gotten several postive culture results on bladder infections. this has been going for 8months they finally did a CT scan and said I have a 1.6cm calcified fibroid in my uterus. Could this be what is causing the pain and getting a positive result on my uranalysis lab work? Is a calcified Fibroid worse than just a fibroid?
No, a small (1/2 inch) calcified fibroid would not cause either pain or urinary problems. Your doctors should continue to look for another cause of your pain. You might consider seeing a pelvic pain specialist – most university hospitals have someone who specializes in this area.
Bill Parker, MD
Hello Dr Parker, note the prior email as I contacted you back in Early Nov. Since then I had the following happen and am very happy…so far.
total wks bled consistantly w/clots: 6
The day bef I went for my secd opinion, I stopped bleeding. go figure….
Had an in ofc(Dr’s) u/s with a very long time experienced u/s tech. She diagnosed the same fibroids but only 3 not 4. also thought there were polyps. thickening of the lining, apprx 1.5cm.
I have a bicornuate ut and the submucosal is in the dip/septum at the top of my ut. he thought this may be the cause of the bleeding.
Needless to say, I requested the conservative approach and had him do a d/c with hystero. I didnt want to do a myo at this point. The Dr found no polyps and couldnt see the submucosal. He just noted there was a lot of “stuff” in there. In my lifetime, I have been thru one early abortion, one miscarriage and one csec/pregnancy. Would this cause scarring internally and may be the tons of “stuff” he found? also, at 44yrs, My hormone levels are not even premenopausal yet.
Since the surgury/treatment, its been heaven and back to normal periods. The two cycles since have been typical and light. Only thing Im dealing with now is low iron. labs were 10.1 in Dec & Jan 11.2. I guess aft all that, it takes awhile to raise the levels. Im hoping that this delays any probs until menopause but we shall see.
-only one ques, have you ever had a patient with a uterine anomolie and treated their fibroids?
Thanks again for being a Dr on top of things. I really enjoy reading your research.
I just got diagnosed with a very large fibroid. And, was told that I need surgery (a hysterectomy)! I don’t have any plans to have any more children,but the thought of that kind of surgery is not very pleasing. I run at least 30 miles a week and have symptoms of frequent urination and constipation. I feel healthy with just these moderate discomforts. Should surgery be my only option? The doctor seem agitated when I asked that question
I have a small submucosal fibroid (approx 2.5cm) or as the Dr put it, the size of a large grape. I have severe cramping and bleeding and it has become a real nuisance, so I have decided it is time to do something about it. I went for a consult with a VERY well renowned reproductive specialist… He has done thousands of these surgeries, so I trust him to do it. He mentioned taking Lupron 1 month prior to surgery to thin the lining of the uterus making the fibroid more accessible. My concern is… all these side effects I am reading about. I am not too sure if it is really necessary for me to take Lupron prior to surgery. If I decide not to, will that interfere with a successful surgery?? After reading the reason to take Lupron prior to fibroid removal, I just don’t fall into any of those categories. I just don’t feel comfortable taking it. What are your thoughts? I guess I should also add, I am 34… no kids, newly married hoping to conceive in the next year or so.
There are many other possible treatment options, often including no treatment if you feel well. Other options include myomectomy, which may be possible to do laparoscopically as an outpatient, or uterine artery embolization, which requires just a one night hospital stay. Look at these webpages:
http://www.fibroidsecondopinion.com/laparoscopic-myomectomy/
http://www.fibroidsecondopinion.com/abdominal-myomectomy/
http://www.fibroidsecondopinion.com/uterine-artery-embolization/
If your doctor seems agitated about these options, then you should consider getting a second opinion from someone who treats women with fibroids on a regular basis and is experienced at treatments other than hysterectomy.
Bill Parker, MD
It was recently discovered that I have 3 fibroids – the largest fibroid is 8.2cm. The others are 2cm and 3cm. The largest fibroid (8.2cm) is intramural. I was informed that all my fibroids are on the outer part of my uterus.
I am 34 years old and have never had children. I would like to have kids someday (hopefully in the near future).
My doctor has advised me not to have any surgery as she does not see the need for it yet. She is suggesting I could try to conceive first and should only consider surgery if I experience difficulties in my pregnancy (such as having a miscarriage).
I am extremely concerned that the 8.2cm fibroid is already really big and will only get bigger when I start to gain weight during pregnancy.
Doesn’t it make sense to remove fibroid now? What are the chances of having a successful pregnancy with an 8.2cm fibroid (that has the potential of getting bigger)?
Please advise…..
About 40% of fibroids grow during pregnancy, with most of the growth occurring during the first three months. So, it is not possible to predict what will happen, but the odds are with you. Since the fibroids are not distorting the uterine cavity, they should not interfere with your fertility. I cannot give specific medical advice over the internet, but your doctor has given you reasonable advice.
Bill Parker, MD
i am 47,having multiple fibriods.largest is 3.3*2.5cm.feel heavyness in lower abdomen and frequent urination sometimes.please advice.
I am 27 y/o and I have had 3 c-sections. I just went for my annual pap and my ob/gyn felt my uterus to be 10-12cm (a little larger than normal). He sent me for an ultrasound. I have a 3cm fibroid and a bicornate uterus. He told me that I would not have to worry unless I develop pain and bleed a lot during my periods. I know the saying goes “If it’s not broken, don’t fix it” but I really don’t want to eventually get pain and bleed heavily. I do not plan on having any more kids, I got my tubes tied after my last child. Should I seek treatment for it even though I am not experiencing any bad symptoms?
There is no reason to have treatment for a problem that you might never have. We don’t understand the causes of fibroid growth very well, but we do know that some fibroids never grow, some grow slowly and others grow more quickly. You should have a pelvic exam twice a year to check to see if they are growing and, of course, if you develop symptoms see your doctor at that point.
Bill Parker, MD
I am 25 years old. I have 2 fibroids and i look like someone who is 5months pregnant. I have all the symptoms. heavy bleeding, pain after and during sex,problem with my bladder, bloatedness. I want to have kids. the fibroids is on the outside of the uterus. Is it possible to have a baby before removing it even if the fibroid is on the outside or i should remove them first?
Fibroids only cause problems with fertility if they bulge into the uterine cavity and then most gynecologists recommend that they be removed. The position of the fibroids is best determined with MRI.
Bill Parker, MD
I have a 6.5 X 6.0 X 8.2 cm fibroid centered on the anterior myometrium to the left of the midline. I also have a second measuring 6.4 X 7.7 X 5.0 cm on the posterior myometrium in the right side of the uterine body. My uterus currently measures 11 X 8.3 X 10.1 cm.
I have pain, bleeding, urinary symptoms ect. and my doctor and I have decided that removing them is best. I have chosen a laparoscopic myomectomy with a d & c hysteroscopy (booked in May).
I have been researching more and I am second guessing my choice. Given the size and location and the fact that I still want children, what would you suggest to be the best treatment for completely removing the fibroids while best maintaining my fertility. I was presented with the lap and d & c or an abdominal myomectomy.
I have a 6.5 X 6.0 X 8.2 cm fibroid centered on the anterior myometrium to the left of the midline. I also have a second measuring 6.4 X 7.7 X 5.0 cm on the posterior myometrium in the right side of the uterine body. My uterus currently measures 11 X 8.3 X 10.1 cm.
I have pain, bleeding, urinary symptoms ect. and my doctor and I have decided that removing them is best. I have chosen a laparoscopic myomectomy with a d & c hysteroscopy (booked in May).
I have been researching more and I am second guessing my choice. Given the size and location and the fact that I still want children, what would you suggest to be the best treatment for completely removing the fibroids while best maintaining my fertility. I was presented with the choices of the lap and d & c or an abdominal myomectomy.
Although abdominal myomectomy is considered the gold standard for women who wish to maintain fertility, if your gynecologist is a skilled laparoscopic surgeon, with specific expertise in laparoscopic suturing, then laparoscopic myomectomy can be performed as skillfully as abdominal myomectomy. The closer the fibroids are to the uterine cavity, as assessed by MRI, the more important it is for the surgeon to have these skills.
Bill Parker, MD
Dear Doctor,
I am 53 years old and have a 9 cm fibroid. It is Intramural/subserosal. It causes a full feeling in my lower abdomen. A urologist says it isn’t the cause of my urinary frequency/leaking. But I do have that problem, too.
I am trying to cover all the bases regarding my options for treatment. An oncological surgeon told me that it needs no follow-up, but if I did do something, it would be a Hysterectomy. I don’t want a hysterectomy.
The fibroid is visible when I lie down and stand up! It is a big lump in my belly.
Trying to find somebody on my insurance plan to help guide me…. What type of doctor? What type of treatment? Is “no follow up” really the best advice with a fibroid of 9 cm?
Thanks for your help.
Depending on the position, a 9 cm fibroid could certainly cause urinary frequency/leaking. A myomectomy can certainly be performed and can be done laparoscopically as an outpatient. You will need to find a skilled laparoscopic surgeon – you should call the best hospital in your area and ask for a recommendation. If you have not gone through menopause yet you can also have uterine artery embolization. This is performed by an interventional radiologist and many hospitals have doctors who can perform this procedure.
If you have not gone through menopause, the fibroid will shrink within 6 or so months after your last period and that should resolve your symptoms.
Take a look at these webpages:
http://www.fibroidsecondopinion.com/laparoscopic-myomectomy/
http://www.fibroidsecondopinion.com/abdominal-myomectomy/
http://www.fibroidsecondopinion.com/uterine-artery-embolization/
I hope this is helpful,
Bill Parker, MD
I am 48 years old with a 6x5x6cm intramural right posterior fibroid found on yearly exam, but not noted a year earlier. MRI done due to maternal family history of uterine sarcoma. Showed a degenerating fibroid. Can an MRI accurately diagnose it as a benign fibroid or could it be a sarcoma? Can a biopsy done on an intramural fibroid? Thanks
Uterine sarcoma may be excluded with an MRI performed with an IV injection of a dye called gadolinium given 40-60 seconds before the MRI images are taken. In addition, blood tests for LDH, both total amount and the iso-enzymes are part of this published protocol. See the study details in the middle of this page:
http://www.fibroidsecondopinion.com/fibroids-and-cancer/
Biopsies of this area is not a good idea since biopsies are not accurate to make a diagnosis of sarcoma.
I hope this is helpful,
Bill Parker, MD
I am 33 and have recently been diagnosed with a 6.4 x 5.4 x 6.7 cm submucosal fibroid in the right wall of the uterus which is partially exophytic. My uterus measures 8.9 x 4.6 x 10.3. I have had 2 previous c-sections. What are the treatment options for my situation? I have had severe pain and heavy bleeding for the past few periods and don’t think I can deal with the pain much longer.
Hi Doctor,
I am a 37 yr old woman with 2 kids and plans to have no more. My regular physician sent me to my GYN due to being very anemic because of prolonged periods. The GYN did an ultrasound because I have the birth control Mirena IUD. He wanted to make sure that it had not moved. The Ultrasound Tech told me that I have a very large uterus and she saw 5 fibroids which measured about 2cm each. The doctor prescribed hormone therapy as treatment. After researching fibroids, I have noticed that I do have the symptoms of frequent urination and continence, bloating and constipation. Should I seek a second opinion or try the hormone therapy and hope for the best.
Heather,
A myomectomy can be performed to remove the fibroid. This can either be done laparoscopically, in the hands of a skilled laparoscopic surgeon, or abdominally through a bikini incision.
Bill Parker, MD
Ali,
Since the fibroid is in the back of the uterus (posterior) and only 6 cm (tennis ball size), it is unlikely that it would make you look pregnant. Abdominal bloating and constipation may be the result of irritable bowel syndrome (IBS), so you might ask a GI doctor about this. Obviously, without me being able to examine you, I cannot really tell what is going on, so you should also discuss this with your gynecologist.
Bill Parker, MD
i think you’re amazing!!!!
i didn’t mention a couple of other things because i didn’t think they were related.
shortly before i was diagnosed w/ the fibroid, i was experiencing other symptoms (leg numbness + strange heat sensations) and my new doctor pretty much told me i was gaining weight with age suggested i buy a book about hormones. i also asked her whether i could have a food sensitivity or IBS and she said possibly, but that there’s not much that i could do about the IBS and to exercise more.
i’m always bloated. would IBS cause someone to look pregnant 24/7 and always look pregnant even if i haven’t eaten (although slightly better than if i ate). my periods are heavy, need to pee often (embarrassing but i’ve had accidents outside home), constipated, and i’m often very irritated easily.
i also took a food sensitivity test and found out that i don’t have celiac. i asked my family doctor about IBS before and she said it’s likely, but there’s no way to test it. she hasn’t been very helpful with anything and just told me to take probiotics.
she told me i was gaining weight with age and suggested a buy a naturopathic book written by her friend about hormones (which i did), but i didn’t believe her it was all that as it didn’t feel correct.
Hi Dr. Parker,
I am 31 years old and suffer from anemia due to very very heavy menstrual periods. My family dr referred me to a reproductive endocrinologist because my husband and I wanted to try to conceive. After the sonohysterogram, he diagnosed me with 4 submucosal fibroids. The largest is just under 5cm, and the next largest is 3.4cm… Those two have an intramural component to it and are located in the lower part of my uterus. The other 2 are smaller and are more in the cavity than in the wall and are closer to the top of my uterus. He put me on lupron for 3 months and I’m supposed to have surgery at the end of March. However, he is unsure about which procedure to do.. He wanted to do an abdominal myomectomy first but is concerned about scarring… So he is considering doing a hysteroscopic myomectomy but he said it’ll be tough because 2 of the fibroids have an intramural component to it…
What do you the best procedure would be in my case to best preserve fertility?
Thanks!
Helen
Hi,
I am 27 yrs old. I have been diagnosed with a broad ligament fibroid on the lateral margin of uterus(outside uterus). The fibroid measures around 5.5 CM. I have painful and heavy menses. Also, pain during and after sex. I do not have children yet. Plan to have in the near future. My gynaec. Suggested myomectomy but I want to go for non-invasive options. I am very concerned about retaining my fertility. Please give ur valuable suggestions. Waiting for your reply eagerly. Thanks