22 Cm Fibroid and Fibroids: What to Know

September 13, 2025

22 Cm Fibroid and Fibroids: What to Know

A uterine fibroid is a benign tumor of the muscle of the uterus (also called a leiomyoma). Many fibroids are small and cause few symptoms, but some grow very large. A 22 cm fibroid is considered “giant” and can make the uterus comparable in size to mid-pregnancy. If you or someone you love has been told they have a fibroid this large, here’s what to expect, how doctors evaluate it, and the treatment options to consider—grounded in guidance from trusted sources.

How big is a 22 cm fibroid—and why size matters

A 22 cm fibroid can fill much of the abdomen. Size matters because larger fibroids are more likely to:

Cause heavy menstrual bleeding, leading to iron-deficiency anemia (fatigue, shortness of breath, dizziness)
Press on the bladder (urgency, frequency, difficulty emptying), ureters (possible kidney swelling/hydronephrosis), or bowel (constipation)
Create abdominal distension, pelvic/low back pain, painful intercourse
Increase risk of venous stasis and, rarely, deep vein thrombosis (DVT)
Complicate pregnancy (pain, malpresentation, preterm labor); many people can still have healthy pregnancies, but risks are higher with large or multiple fibroids

Very large fibroids are less likely to be controlled with lifestyle changes or standard hormonal contraception alone. They often require a procedure if symptoms are significant.

Symptoms and red flags

Common symptoms include heavy or prolonged periods, bulk-related pressure, and pain. Seek urgent care if you experience:

Severe, sudden pelvic pain with fever or nausea (possible degeneration or torsion of a pedunculated fibroid)
Heavy bleeding soaking through pads or tampons hourly for several hours, signs of anemia (fainting, chest pain, shortness of breath)
Inability to urinate, severe constipation, or new leg swelling

How doctors evaluate a very large fibroid

History and exam: Focus on bleeding pattern, pain, fertility goals, and bulk symptoms.
Imaging: Pelvic ultrasound is first-line. MRI is often used for large fibroids to map number, size, and location and to plan surgery or embolization. MRI can suggest but cannot definitively exclude cancer.
Laboratory tests: Complete blood count and ferritin to assess anemia; pregnancy test if applicable; renal function if urinary tract compression is suspected.
Endometrial sampling: Recommended in those with abnormal uterine bleeding who are 45+ or younger with risk factors for endometrial pathology (per ACOG). This evaluates the uterine lining, not the fibroid itself.

Is it cancer?

Uterine fibroids are benign. An aggressive cancer called leiomyosarcoma is rare. Based on FDA safety communications, the risk of finding an unsuspected uterine sarcoma during surgery for presumed fibroids is low but real; risk increases with age and after menopause. Imaging cannot reliably rule it out, which is why surgical approach and tissue handling (avoiding uncontained power morcellation) are carefully considered in shared decision-making.

Treatment options: tailoring to your goals

The best plan depends on your symptoms, desire for future pregnancy, and overall health. For a 22 cm fibroid, procedures are commonly needed, but medical therapy often plays an important supportive role—especially to control bleeding and correct anemia before any intervention.

Medical therapy (often as a bridge or for symptom control)

Iron therapy: Oral or intravenous iron to treat anemia.
Non-hormonal for bleeding: Tranexamic acid can reduce menstrual blood loss.
Hormonal options: Combined hormonal contraceptives or progestin-only methods and the 52 mg levonorgestrel intrauterine system can reduce bleeding (though IUD placement may be difficult or less effective with very large cavity distortion).
GnRH agonists or antagonists with add-back therapy: Short-term use can shrink fibroids and reduce bleeding, helping optimize hemoglobin before surgery and sometimes making procedures easier. Because these medicines suppress ovarian hormones, they can cause hot flashes and affect bone density; add-back therapy (low-dose estrogen/progestin) is used to mitigate side effects. Several oral GnRH antagonist combination therapies are FDA-approved for heavy menstrual bleeding from fibroids in premenopausal patients; discuss duration limits and risks with your clinician.

Medical therapies rarely eliminate a 22 cm fibroid but can significantly improve safety and symptoms around a procedure.

Procedural and surgical options

Myomectomy (fibroid removal, uterus preserved): Best for those desiring future pregnancy. For a 22 cm fibroid, an open abdominal approach is often required; minimally invasive approaches may not be feasible or safe depending on size, number, and location. Preoperative medical shrinkage can help. Risks include bleeding, transfusion, adhesions, and recurrence of fibroids over time.
Hysterectomy (removal of the uterus): Definitive cure for fibroids and bleeding; ovaries can often be preserved if not indicated for removal. For very large uteri, an abdominal hysterectomy may be recommended. Recovery and scar size vary by approach.
Uterine artery embolization (UAE/UFE): A minimally invasive radiology procedure that blocks blood flow to fibroids, shrinking them and improving bleeding and pressure symptoms. It can be effective for large fibroids, though post-procedure pain/fever (post-embolization syndrome) and infection risk are higher in large-volume disease. UAE is generally not first-line for patients strongly pursuing future pregnancy; discuss risks to fertility with your physician.
Radiofrequency ablation (RFA): Laparoscopic (Acessa) or transcervical (Sonata) energy ablation can shrink fibroids. Most programs limit use to smaller or moderate-sized fibroids; a 22 cm mass typically exceeds size parameters.
Hysteroscopic myomectomy: Used only for submucosal fibroids inside the uterine cavity; not applicable to large intramural or subserosal masses.

About morcellation and safety

When minimally invasive surgery is considered, tissue must often be removed in pieces. The U.S. FDA advises that if laparoscopic power morcellation is used, it should be performed only with a legally marketed tissue containment system and only in appropriately selected patients, because uncontained morcellation can spread an unsuspected cancer. For very large fibroids, many surgeons recommend open approaches to avoid this risk and to allow safe specimen removal.

Planning for treatment: optimizing your health

Correct anemia: Iron supplementation, and sometimes IV iron, reduces transfusion risk and helps recovery.
Imaging and mapping: MRI can refine the plan and anticipate challenges.
Kidney and vascular checks: If there’s urinary tract compression, your team may assess kidney function or perform renal ultrasound. Preventive measures for blood clots may be used around surgery.
Fertility counseling: If pregnancy is a goal, discuss how each option affects fertility and timing to conceive after treatment. Myomectomy is the standard fertility-sparing surgery; UAE and RFA have uncertain or mixed fertility data.

Frequently asked questions

Can a 22 cm fibroid go away on its own?

No. Fibroids may shrink after menopause, but a mass this large rarely regresses enough to relieve symptoms without intervention.

Will diet or supplements shrink it?

Healthy habits support overall well-being, but no diet or over-the-counter supplement reliably shrinks large fibroids. Use caution with unproven remedies.

What about pain while I wait for treatment?

Heat, NSAIDs as appropriate, hydration, and short-term hormonal regimens can help. Seek urgent care for severe pain, fever, or heavy bleeding.

Bottom line

A 22 cm fibroid is a major source of symptoms and deserves a tailored plan. Most people benefit from a combination of medical therapy to control bleeding and build blood counts, followed by a definitive procedure—most commonly myomectomy (if preserving the uterus) or hysterectomy. Uterine artery embolization can be an effective alternative in selected cases. Work with a gynecologist and, when appropriate, an interventional radiologist to choose the option that best fits your goals and medical profile.

Trusted resources

NIH MedlinePlus: Uterine Fibroids – https://medlineplus.gov/uterinefibroids.html
NICHD/NIH: Uterine Fibroids Overview – https://www.nichd.nih.gov/health/topics/uterine/conditioninfo
ACOG: Uterine Fibroids (Patient FAQ) – https://www.acog.org/womens-health/faqs/uterine-fibroids
FDA Safety Communication: Contained Morcellation – https://www.fda.gov/medical-devices/safety-communications/update-perform-only-contained-morcellation-when-using-laparoscopic-power-morcellators-fda-safety
RadiologyInfo (ACR/RSNA): Uterine Fibroid Embolization – https://www.radiologyinfo.org/en/info/uterine-embol

This article is informational and not a substitute for personal medical advice. If you suspect fibroids or have rapidly worsening symptoms, consult a qualified clinician.