If a fibroid is found to be 40 cm in size, what is that relative to the size of the entire uterus? What should be done about it?

--M.M.

I'm hoping you made a typo here and really mean 40 mm (or 4 cm); 40 cm is the size of a full-term pregnancy, and a 40 cm uterus would be all the way up to your ribcage! In a woman who has never had children, the average uterus is about 8 cm long by 5cm wide by 2.5 cm thick; in a woman who has had a child, those measurements are about 9 by 6 by 4 cm. Since 1 inch equals 2.5 cm, in a woman who hasn't had children, the uterus is about 3 x 2 x 1 inch. A fibroid that is 4 cm in diameter, therefore, is about half as big as the average uterus, so it increases the size of the uterus by 50 percent.

What is more important than the absolute size of the fibroid is what symptoms -- if any -- it is causing. Fibroids, which are benign growths of the uterine muscle, may cause heavier and/or crampier periods. They may cause a sensation of pelvic heaviness or pressure, and if they press on the bladder, may lead to frequent urination. Just because a fibroid is there does not mean anything need be done about it; fibroids only need to be treated if they are causing you problems.

A doctor can remove the fibroid in a procedure called a myomectomy. (The proper medical term for a fibroid is leiomyoma.) Myomectomies may be done through an abdominal incision, a laparoscope or a hysteroscope, depending on the number of fibroids, their size and their location within the uterus. For women who have completed their childbearing and whose fibroids are causing problems such as heavy bleeding, a hysterectomy is the most definitive means of treatment. Other treatment options include embolization of the blood vessels supplying the fibroid, myolysis ("cooking" the fibroid via laparoscopy, so it shrinks) or cryomyolysis (freezing the fibroid, again through laparoscopy). The latter three procedures are relatively new and are not widely available.

Medication may be used on a short-term basis to shrink the fibroid; unfortunately, once the medication is stopped, the fibroid may grow again. Medical therapy is most useful in women approaching menopause (because fibroids tend to stop growing after menopause) or to make a planned surgery easier.

Your doctor can discuss these options with you. Of course, if 40cm was not a typo, surgical removal through via a pubic-bone-to-breast-bone incision will be what the doctor orders.