shows that your uterus is enlarged due to the presence of multiple fibroids (myoma). But this can be confirmed to be a fibroid only after histopathology of removed tumor.
Fibroids are smooth muscle
tumors of uterus which are very common in reproductive age group and regress after menopause
Fibroids need treatment only if they are huge in size or symptomatic in the form of pain abdomen , bleeding problems( frequent heavy periods
) or pressure symptoms (increased urinary frequency, constipation
, urinary retention
or heaviness in abdomen)
You have not mentioned the reason you got a scan done. But what i get to know from your ultrasound findings is that your fibroids are definitely symptomatic for you. As the size you have mentioned about your uterus and fibroids, its quite obvious that you might have a lump (swelling) in abdomen which you might have felt. Also you are of 49yrs and by now you would be finishing your menses in a year or so. But since your fibroids are large enough they wont regress on their own after menopause. So its better you get them removed particularly if you have irregular menses or continue menstruating after 50yrs.
The best treatment for you would be total hysterectomy
with bilateral salpingo-oophorectomy( removal of uterus along with both tubes and ovaries) as your age is 49yrs and you must have completed family too. Besides you have multiple fibroids and big enough which cant be and should not be managed by conservative procedures like myomecyomy.
So i suggest you meet up a gynecologist personally, and plan your surgery. In case you have irregular menses, do get a minor procedure called D&C before the final surgery hysterectomy. This is essential to rule out cancer before any major surgical procedure.