These little fibrous balls of excess are the cause of more ultrasound conversations about incidental findings than anything else in my practice. Women with no symptoms but an enlarged uterus noted on exam, or pressure and/or heavy bleeding, are the all too common recipients of this diagnosis.
This one is near and dear to my own heart because my own fibroids were diagnosed when I was but a lowly medical student. I went in for a routine Pap test and Gyne exam. My doctor said that he felt something in my pelvis. Sure enough it was a 4-centimeter fibroid, about the size of a plum.
Sidebar: Have you ever noticed that gynecologists love to describe body parts with fruit or sports? “Her uterus was the size of a grapefruit.” “The cyst on her ovary was the size of a softball.” It is easier to relate to women with objects rather than just measurements. I just find it kind of funny sometimes when I get to the apricot level and I think, man, I’m going through a lot to find a food to describe this mass.
Double sidebar: My Doc that diagnosed my fibroids was a man. Male OB/GYNs can sometimes feel like a dying breed because women often seem to prefer to see women for their lady issues. No judgement there, but don’t discount the fellas, ladies. Male OB/GYNs went through the same training and are just as knowledgeable as we are. The more seasoned guys also have experience on their side. I just had to make that point because one of my partners is a man. He has a strong following of patients, but newbies to the practice sometimes question seeing him. Don’t. You won’t be sorry.
We re-enter my person fibroid journey when I was pregnant with my eldest son. My dominant fibroid (yes, there were multiple, and no that is not a thing but for the purposes of this story my dominant fibroid was the largest one), was about 10 centimeters- about the size of a softball. Keep in mind, the head of a baby at term is about 10 centimeters from one side to the other. My co-residents used to refer to it as my second baby head because you could even feel it from the outside. After I had my son, it shrank in size dramatically and didn’t bother me. I was always on birth control methods that caused me to not have a period, and I believed that that helped to stabilize growth.
How I Feel About Treating Fibroids
Fibroids generally don’t bother me as the physician and provider, unless they bother the woman who I am caring for. Women with fibroids who don’t have heavy bleeding or massive uteruses that are causing uncomfortable bladder or bowel symptoms, can keep them as far as I am concerned. As with any rule, there are always exceptions.
The three exceptions to my “But these fibroids aren’t bothering me” rule, are scenarios involving desired pregnancy, those where bleeding is so heavy and abundant that anemia is a concern, and the situations where the fibroids are growing rapidly in size. When pregnancy is desired, it is possible to achieve pregnancy when fibroids are in place (guilty as charged). However, if a person is deviating from the expected or standard time that it should take to get pregnant, fibroids can be possibly removed to improve the fertility rates. If heavy bleeding is causing anemia, iron supplementation and sometimes removal may need to be discussed. If the size of the uterus is changing rapidly within 6 months to a year, removal of fibroids may be in order to make sure cancer isn’t present.
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