What happens if large fibroids go untreated?

Uterine fibroid size can vary from less than an inch to larger than a grapefruit. So, do all fibroids need to be removed?

For the vast majority of patients, the answer is no. “Watchful waiting” is the usual course of treatment for most fibroids, particularly if they aren’t causing any symptoms. (i)

Types of Fibroids

1. Intramural fibroids, the most common, grow in the wall of the uterus.
2. Subserosal fibroids grow on the outside of the uterine wall. As they grow larger they can cause pressure on nearby organs or pain due to their size.
3. Submucosal fibroids grow just underneath the uterine lining and can crowd into the uterine cavity, leading to heavy bleeding and other more serious complications. These are the rarest type of fibroid.
4. Pedunculated fibroids grow on small stalks or stems and can grow either outside the uterus or inside the uterine cavity.

Between 70 percent and 80 percent of women develop a fibroid tumor by the time they reach age 50. (ii) You may also develop more than one type of fibroid.

Estrogen tends to stimulate the growth of fibroids in many cases. In fact, during the first trimester of pregnancy, about one-third of fibroids will grow larger, but will then shrink after the birth. (ii) Generally, uterine fibroids shrink after menopause, but postmenopausal hormone therapy may cause symptoms of uterine fibroids to continue.

Fibroids and Weight Gain

Most women with uterine fibroids have an enlarged uterus. In fact, doctors describe the size of fibroids and their effect on a woman’s uterus as they would a pregnancy, such as a 14-week-sized fibroid uterus. It’s not uncommon for a fibroid-affected uterus to grow to the size of a four- to five-month pregnancy. (iii)

A fibroid is considered “giant” if it weighs 25 pounds or more. (iv) The largest fibroid in the world weighed a record 140 pounds. (iv) That’s like carrying around the weight of another person!

The good news is that once any fibroids are removed, your uterus should return to its previous size and you’ll no longer suffer from the bloating that often accompanies fibroids.

Evaluating Uterine Fibroid Size for Removal

Women with large or symptom-producing fibroids may need to have an imaging study done to evaluate uterine fibroid size to determine whether it needs to be removed. The risk of not getting treatment is that fibroids sometimes grow to a size that often leads to significant symptoms, eventually requiring removal.

Larger fibroids or those that continue to grow may lead to complications.

• If submucosal fibroids are found on the inside of the uterus and are large enough to misshape the uterine lining, they should be removed to prevent reproductive problems. (iii)
• If fibroids are larger than a 12- to 14-week pregnancy (about the size of a large grapefruit), the risk of complications during surgery, such as injury to the ureter or bladder, increases. (i)
• Left untreated, very large fibroids can begin to degenerate or burst, even if they aren’t causing any symptoms. (i) Degeneration occurs when the growing fibroid outgrows its blood supply, causing the cells of the fibroid to die. This typically causes abrupt, severe pain and tenderness.
• When fibroids reach the size of a grapefruit (4 – 6 inches), there is a rare association with blood clots in the lungs, which can be deadly. (i)
• Rapidly growing large fibroids may be a sign of a rare cancerous form of fibroid, called a leiomyosarcoma. This type of tumor can’t be differentiated from a non-cancerous (benign) fibroid using ultrasound, MRI, or other imaging studies. However, this type of fibroid only occurs in less than 1percent of uterine fibroids, and these cancerous tumors are not believed to grow from a benign fibroid. (ii)

Treatment Options for Uterine Fibroids

There are several uterine fibroid treatment options:

• Uterine fibroid embolization (UFE) uses tiny particles about the size of sugar crystals that are injected into the blood vessels that lead to the uterus. The particles block the flow of blood to the fibroid, causing it to shrink and die. This minimally invasive procedure can be performed by an interventional radiologist on an outpatient basis. It doesn’t require open surgery and offers relief of symptoms with fewer risks, less pain, and a faster recovery compared to surgical procedures.
  
• Magnetic resonance imaging-guided (MRI) ultrasound surgery uses ultrasound waves to destroy fibroids. Waves are directed at the fibroids through the skin with the help of magnetic resonance imaging.
• Endometrial ablation destroys the lining of the uterus. This procedure is best for small fibroids that are less than 3 centimeters in diameter. (v)
• Hysterectomy is the surgical removal of the uterus. Because this surgery removes the fibroids along with the uterus, there is no chance of becoming pregnant after undergoing a hysterectomy.
• Myomectomy is another surgical option to remove all types of fibroids. There are three approaches to performing a myomectomy: hysteroscopy, laparotomy, and laparoscopy.

Talk to your healthcare provider about the various uterine fibroid treatment options so that you fully understand the risks associated with surgery, as well as the benefits of a minimally invasive alternative treatment such as uterine fibroid embolization.

Do you think you’re a candidate for UFE? Download our free information sheet Understanding Uterine Fibroid Embolization to learn more or call 844-UFE-CARE (833-2273) to schedule an appointment with a vascular specialist.

Sources: (i) Bradley, J. G., MD. (2011, June 22). _Uterine Fibroids. Retrieved June 15, 2018, from http://www.obgyn.net/laparoscopy/uterine-fibroids (ii) Stöppler, M. C., MD. (2018, February 28). Uterine Fibroids Symptoms, Treatment, Pictures, Causes, Surgery. Retrieved July 3, 2018, from https://www.medicinenet.com/uterine_fibroids/article.htm#uterine_fibroids_definition_and_facts (iii) Brigham and Women’s Hospital. (n.d.). About Uterine Fibroids. Retrieved June 15, 2018, from http://www.fibroids.net/fibroids.html (iv) Bora, A., Prasad, M., & Gupta, A. (2017). Large Degenerated Broad Ligament Fibroid. _Journal of Postgraduate Gynecology & Obstetrics, 4(1). Retrieved July 5, 2018, from http://webcache.googleusercontent.com/search?q=cache:8Joo72tk2HAJ:www.jpgo.org/2017/01/large-degenerated-broad-ligament-fibroid.html+&cd=1&hl=en&ct=clnk&gl=us

(v) American College of Obstetricians and Gynecologists. (2011, May). Women’s Health Care Physicians. Retrieved June 17, 2018 from https://www.acog.org/Patients/FAQs/Uterine-Fibroids

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• Uterine fibroids are abnormal growths of muscle tissue that form in or on the walls of the uterus

• Symptoms include irregular bleeding between periods and pelvic pain

• Estrogen and progesterone play a role in the growth of fibroids

• You might not notice them, but if they become problematic, they are treatable

Like uterine polyps, uterine fibroids are a common cause of changes in bleeding and period pattern.

While polyps are more likely to develop around the time of menopause, fibroids most often develop during the reproductive years. Here’s how to know if you have fibroids.

What they are

Uterine fibroids are abnormal growths of muscle tissue that form in (or on) the walls of the uterus. Fibroids are benign (not harmful/life threatening), but can cause symptoms such as irregular vaginal bleeding and pelvic pain (1,2). Uterine fibroids are sometimes called myomas or leiomyomas in medical literature.

Uterine fibroids are very common. About 3 in 4 women may have them at some point in their lives (3). They are most common during the reproductive years (2,3), and are more likely to occur in people of African ancestry (4). Uterine fibroids most often cause no symptoms at all (5) and often shrink after menopause (6,7). In other cases, untreated fibroids may lead to problems such as heavy bleeding, anemia, pelvic pain or pressure, fertility changes, and complications during pregnancy (1,2,8). Symptoms depend on the size, location, and number of fibroids.

Download Clue to track your menstrual pain.

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If you think you may have uterine fibroids, tracking your bleeding, pain, and any other symptoms with Clue can provide your healthcare provider with information that may help with diagnosis and in forming a treatment plan. Early treatment can reduce the risk of complications.

What you might notice

Some of the most common symptoms of uterine fibroids are:

• Periods that are heavy, long, and/or painful (1,9)

• Irregular bleeding (9)

• Pelvic pressure or pain (2,10)

• Frequent urination and difficulty emptying the bladder (1)

• Constipation (10)

• Difficulty getting pregnant or carrying to term (2)

In rare cases, uterine fibroids can become very large, twisted, or infected. These situations can create intense symptoms, and may require immediate medical treatment (11,12).

Some studies show that pregnancy may cause fibroids to grow slightly bigger in up to 1 in 3 people (2,13). This might make some symptoms more noticeable. The most common complication of uterine fibroids in pregnancy is pain, usually felt in the second and third trimesters (14,15).

Why they happen

Uterine fibroids occur when muscle cells in the uterus multiply too many times. As cells multiply, lumps of various shapes and sizes are formed. They can be numerous or few—some people might only have one. These lumps can grow on the inner and outer surfaces of the uterus, as well as within the uterine wall.

Research shows the hormones estrogen and progesterone play a role in the growth of uterine fibroids. This is probably why fibroids tend to shrink after menopause, when production of these hormones decreases (6,7).

Some people are more likely than others to develop uterine fibroids, and in fact fibroids may be inherited genetically (16). This means someone is more likely to develop fibroids if a family member has had them. People of African ancestry are significantly more likely to develop them (4). Someone is also more likely to have uterine fibroids if they have hypertension (17,18), or polycystic ovary syndrome (19). They are more common in people who have an earlier age at first menstruation (menarche) (4), and people who have not given birth, though this may be because women with fibroids may have difficulty conceiving (2). Maintaining a diet high in red meat consumption may also increase the risk of uterine fibroids (20), as may beer consumption (21).

Different types of fibroids create different symptoms. Fibroids embedded within the uterine wall (intramural fibroids) can change the shape of the uterus, which may cause changes in fertility (22). Fibroids that project into the inside of the uterus (submucosal fibroids) may also cause difficulty in becoming or staying pregnant (23).

Why get them checked out?

Uterine fibroids are generally harmless and often go away on their own. When symptoms occur, however, untreated fibroids can interfere with a person’s quality of life and may lead to complications such as anemia. Anemia is a condition when the body doesn’t have enough healthy red blood cells to function properly. This can happen when uterine fibroids cause heavy bleeding (7).

Some uterine fibroids may also interfere with the probability of becoming pregnant, and may increase the chance of miscarriage, but more research is needed here (22,23). In these cases, treatment can help people become and stay pregnant.

Rarely, uterine fibroids can become very large, twisted, or infected. These situations can create symptoms that are intense, and may require immediate medical treatment (11,12).

How they’re diagnosed

A healthcare provider will probably ask questions about symptoms, medical, and menstrual history. Some uterine fibroids are diagnosed with a physical exam. Other diagnostic methods may include:

• A pelvic ultrasound (sonogram)

• An MRI

• A sonohysterogram (an ultrasound performed after the uterus is filled with fluid) (24)

What you can do about uterine fibroids

You and your healthcare provider may choose to leave fibroids with mild symptoms untreated. Tracking your symptoms can then help you know if your fibroids are changing, and at what point a treatment plan might be helpful. When fibroids do become problematic, there are many different options for managing and treating them, and for preventing their future formation:

Medications

In some cases, hormonal medications are prescribed to treat uterine fibroids. These include Selective Progesterone Receptor Modulators (SPRM) which change the effect of progesterone in the body, and Gonadotropin Releasing Hormone (GnRH) Agonists which block the body’s production of both progesterone and estrogen. These medications have been shown to lessen the size and number of uterine fibroids over time in people of reproductive age (25,26).

Lifestyle Changes

Maintaining a healthy weight may help lessen the occurrence uterine fibroids (16,27). Getting enough exercise and eating a balanced diet may also help with this. Specifically, a diet low in red meat and high in green vegetables may help to lessen the prevalence and severity of fibroids in some people (20).

Non-surgical procedures

Some symptomatic uterine fibroids may be destroyed through non-invasive procedures like uterine artery embolization and radiofrequency myolysis. These procedures cut off blood supply to fibroids. MRI-guided focused ultrasound surgery (FUS) is an example of a newer technique that uses soundwaves to destroy fibroids (25).

Surgery

Uterine fibroids are sometimes treated with minimally invasive surgical procedures, via the abdomen or pelvis. Some cases of fibroids may be treated with a procedure called an abdominal myomectomy, in which problematic fibroids are surgically removed (25). In severe cases, a hysterectomy, or a removal of the uterus, may be performed (25).

What to track in Clue

Essential to track:

Helpful to track:

• blood volume

• stool

• sex (if trying to get pregnant)

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