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What are my treatment options for fast growing fibroids?

Gynaecology Women's Health

I’m a 30 yo female with one subserosal fibroid measuring 8.7 by 7.4 by 7.8cm. Fibroid grew about 1.5 cm over past 6 mths. Not causing much problem at the moment, except that it is growing quickly. 1 doctor has recommended surgery, but the other did not. What are my treatment options for fast growing fibroids? What are the considerations? Thanks!

DOCTOR’S ANSWER (2)

Thank you for your question.

Fibroids are very common in women,especially those in the reproductive age group. They are usually mostly benign growths that grow mostly within the uterus.

A 8.7cm x 7.4cm x 7.8cm sized fibroid is relatively significant in size, and is actually of a size whereby surgical removal may be recommended.

The concern with having a large and fast growing fibroid is the rare chance of it being malignant,when it becomes a leiomyosarcoma. Of course, the only way to definitely know for sure is only with histology when the fibroid is removed.

Large fibroids can also cause other complications such as external compression on the bladder causing urinary retention or frequency. Some people can also experience heavier periods with fibroids, or abdominal pain if the fibroid undergoes degeneration.

 Given that you are only 30 years old, you have to also consider other factors such as: how this fibroid can affect your pregnancy if you do get pregnant (it can significantly grow much bigger during pregnancy), and also the chances of this fibroid coming back even if you choose to remove it with surgery.

In your situation, surgery will be the most effective way to remove the fibroid. Other considerations can include hormonal injection to try to reduce the size but this may not be effective or suitable for you since you are still quite young.

Ultimately, the important thing to note is that you have to weigh your own risks and benefits of choosing to go for surgery to remove the fibroid or choosing to closely monitor it. An honest and detailed discussion with your gynaecologist can help guide you in making your decision.

Hope this helps!

Regards,

Dr Michelle Chia

185 views 3 Feb 2019

Hi, 

Fibroids are basically smooth muscle tumours that grow from the muscle wall of the uterus. They do not serve any function but instead may adversely affect the physical and reproductive well being of the female patient, depending on the size, depth, number and location of the fibroid.
 
Whether or not to intervene will depend on whether the patient has symptoms, or the potential to cause problems in the near future.
 
Subserosal fibroids are in the outer layer of the uterus and can grow to a large size without any symptoms. This is because the abdominal / pelvic cavity has a lot of space for it to expand. A near 9cm fibroid in a young patient with the potential to grow larger can cause pressure issues in pregnancy. However, there are some who do cope.
 
Treatment options include surgery to remove the fibroid (Laparoscopic/ Robotic/ open surgery), High Intensity Focused Ultrasound (HIFU) to heat and destroy the fibroid core, and oral medication such as ulipristal to try to shrink the fibroid. 
 
The patient will have to understand the advantages and limitations of each of these options and have a detailed discussion with the gynaecologist, to decide on the appropriate option. 
 
Hope this helps.
 
Best rgds
 
Dr Fong Yoke Fai
152 views 3 Feb 2019
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