Should You Remove a Large Subserosal Fibroid Without Symptoms?

Subserosal leiomyoma measuring 10 to 11 centimeters?

Hello Doctor, in April of this year, during a pap smear at the clinic, I discovered a subserosal uterine fibroid measuring approximately 10 to 11 centimeters.
However, this fibroid has not caused any discomfort in my daily life; my menstrual flow and cycle are all normal.
The only slight issue I've noticed is that I seem to urinate a bit more, but it hasn't reached the level of frequent urination.
This month, I went to a teaching hospital for a follow-up examination.
Both doctors recommended surgical removal.
I would like to ask if, in the absence of any discomfort, surgery is truly the more appropriate option, or should I wait until symptoms arise before addressing it?

Eva, 30~39 year old female. Ask Date: 2020/07/11

Dr. Wu Xianghui reply Obstetrics and Gynecology

Surgery can be postponed until symptoms develop.
However, a fibroid that is around 10 centimeters can still be treated with minimally invasive surgery.
If the fibroid continues to grow, the only option may be an open myomectomy.

Reply Date: 2020/07/11

More Info

When it comes to managing a large subserosal fibroid, especially one that measures around 10-11 cm and is asymptomatic, the decision to proceed with surgical removal can be complex and should be made after careful consideration of various factors.

Subserosal fibroids are non-cancerous growths that develop on the outer wall of the uterus. They can vary in size and may or may not cause symptoms. In your case, you mentioned that you have not experienced any significant discomfort, and your menstrual cycle remains normal. The only minor issue you noted is a slight increase in urination, which is not severe enough to be classified as frequent urination.

The general approach to managing fibroids often involves a "watchful waiting" strategy, particularly when the fibroids are asymptomatic. Many healthcare providers recommend monitoring the fibroid's size and any potential changes over time, especially if there are no troubling symptoms. Regular follow-up ultrasounds can help assess whether the fibroid is growing or if any new symptoms develop.

However, there are several reasons why your doctors might recommend surgical intervention, even in the absence of symptoms:
1. Size of the Fibroid: A fibroid of 10-11 cm is considered relatively large. Larger fibroids can sometimes lead to complications, such as pressure on surrounding organs (like the bladder or intestines), which may not be immediately apparent. Over time, they can also lead to issues like anemia due to heavy menstrual bleeding if they start to affect your menstrual cycle.

2. Potential for Symptoms: While you currently have no symptoms, there is a possibility that the fibroid could cause problems in the future. Some women may develop symptoms as fibroids grow, including pelvic pain, pressure symptoms, or changes in menstrual patterns.

3. Risk of Degeneration: Large fibroids can sometimes undergo degeneration, which can lead to acute pain and other complications. Surgical removal can prevent these potential issues.

4. Fertility Considerations: If you are considering future pregnancies, some studies suggest that large fibroids may impact fertility or pregnancy outcomes. Surgical removal might be recommended to optimize your reproductive health.

5. Personal Preference and Quality of Life: Ultimately, the decision to undergo surgery should also take into account your personal preferences and how you feel about the fibroid's presence. If the idea of having a large fibroid causes you anxiety or concern, that is a valid reason to consider surgical options.

In conclusion, while many women with large, asymptomatic fibroids can safely monitor their condition, the recommendation for surgery often stems from a desire to prevent future complications or address potential risks. It is essential to have an open discussion with your healthcare provider about the risks and benefits of surgery versus continued observation. If you feel uncertain, seeking a second opinion from another gynecologist may also provide additional clarity and reassurance. Ultimately, the decision should align with your health goals, lifestyle, and comfort level.

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