Uterine fibroids are common non-cancerous growths. Also known as leiomyomas, these growths are composed of muscle and fibrous tissue. They are common, affecting 40% to 80% of individuals with a uterus by age 50. They vary significantly in size and number, from microscopic to very large.
Understanding Fibroid Weight
Uterine fibroids vary dramatically in weight, from microscopic to exceptionally large. Many fibroids remain small, comparable to a seed. Others can grow to the size of a plum, orange, or even a grapefruit. In rare instances, fibroids can become extremely large, reaching the size of a watermelon or larger.
Fibroids have been reported to reach significant weights. The largest fibroid ever recorded weighed 140 pounds (63.3 kg), though this was discovered post-mortem. Among living patients, a fibroid weighing 100 pounds (45.5 kg) has been successfully removed. More recently, a 61-pound (28 kg) fibroid was removed from a woman in Singapore. While these extreme cases are uncommon, they demonstrate the considerable mass fibroids can accumulate.
What Makes Fibroids Grow Large
Fibroid growth is influenced by hormones. Estrogen and progesterone, which regulate the menstrual cycle, appear to promote fibroid development and growth. Fibroids contain more cells that bind to these hormones, explaining why they often grow during reproductive years and may shrink after menopause when hormone levels decline.
Genetic predisposition also contributes to fibroid development; a family history of fibroids increases an individual’s risk. Specific gene changes have been identified in fibroid tissue. Ethnicity is a factor, as individuals of Black descent are more likely to develop fibroids at younger ages, have more or larger fibroids, and experience more pronounced symptoms. Fibroids generally grow slowly over time, though their growth patterns can vary among individuals.
Effects of Heavy Fibroids
Large and heavy fibroids can cause physical impacts due to pressure on surrounding organs. Individuals may experience a sensation of fullness or pressure in the lower abdomen or pelvis. This pressure can extend to the bladder, leading to frequent urination or difficulty fully emptying the bladder. Similarly, pressure on the rectum can result in constipation or discomfort during bowel movements.
Heavy fibroids are associated with significant menstrual changes, including heavy or prolonged bleeding and painful periods. This heavy bleeding can sometimes lead to anemia, causing fatigue. In some cases, large fibroids can cause backache or leg pain by pressing on nerves in the lower back. The sheer size and weight of these fibroids can also lead to visible abdominal swelling, making an individual appear pregnant.
Options for Managing Large Fibroids
Managing large or heavy fibroids involves various approaches, tailored to individual symptoms and circumstances. For individuals who have no symptoms, a healthcare provider may recommend watchful waiting, monitoring the fibroids with regular check-ups. Medical management often involves hormonal therapies that can help control symptoms like heavy bleeding or, in some cases, reduce fibroid size. These medications include gonadotropin-releasing hormone (GnRH) agonists, which create a low-estrogen state, and certain progestins or oral contraceptives.
When medical options are not sufficient, surgical interventions are considered. Myomectomy is a procedure to remove fibroids while preserving the uterus, making it an option for those who wish to maintain fertility. Hysterectomy, the surgical removal of the uterus, offers a definitive solution for symptomatic fibroids, particularly for individuals who do not desire future pregnancies. Minimally invasive procedures like uterine artery embolization (UAE), which blocks blood flow to the fibroids, and magnetic resonance-guided focused ultrasound (MRgFUS) can shrink fibroids without traditional surgery. The choice of treatment depends on factors such as the fibroid’s size and location, the severity of symptoms, and the patient’s individual health goals.