Should uterine fibroids undergo surgery?

Whether uterine fibroids require surgical removal needs to be comprehensively judged based on factors such as the size of the fibroids, growth location, severity of symptoms, and the patient's fertility needs. The main influencing factors include fibroid diameter exceeding 5 cm, causing severe anemia or compression symptoms, rapid growth in a short period of time, affecting reproductive function, and suspected malignant tendency.

1. The diameter of fibroids exceeds 5 cm

When ultrasound examination shows that the diameter of uterine fibroids continues to exceed 5 cm, most doctors will recommend surgical treatment because it may cause pressure on the pelvic organs. This type of fibroids can easily cause mechanical compression symptoms such as frequent urination and constipation, and conservative treatment usually has limited effect. Commonly used clinical procedures include laparoscopic myomectomy, hysteroscopic electroresection, etc. The specific selection needs to be combined with the assessment of the location of the fibroids.

2. Cause severe anemia or compression symptoms

When fibroids cause excessive menstrual flow and cause moderate to severe anemia, or significantly compress the bladder and rectum, causing difficulty in urination and tenesmus, surgical intervention should be considered. Submucosal fibroids are particularly likely to cause abnormal uterine bleeding. When conservative drug treatment is ineffective, hysteroscopic surgery can effectively improve symptoms.

3. Rapid growth in a short period of time

If premenopausal patients find that the volume of fibroids has increased beyond the size of the uterus at 3 months of pregnancy within half a year, or if fibroids do not shrink but increase after menopause, they need to be alert to the possibility of malignant transformation. This situation requires diagnostic surgery with rapid intraoperative pathology to rule out uterine sarcoma.

4. Affect reproductive function

Fibroids that protrude into the uterine cavity may change the shape of the endometrium and prevent the fertilized egg from implanting. For patients who desire fertility and have clear causes of infertility, removal of intramural or submucosal fibroids can improve the success rate of pregnancy. However, care should be taken to preserve the normal myometrium during surgery to avoid the formation of severe intrauterine adhesions after surgery.

5. Suspected malignant tendency

When imaging examination shows that fibroids have abnormally rich blood flow signals, unclear boundaries, or significantly elevated tumor markers, surgical exploration should be performed regardless of the severity of the symptoms. Those who are pathologically confirmed to be benign fibroids after surgery also need regular follow-up, while patients with malignant uterine sarcomas need to expand the scope of surgery.

For patients who are not yet indicated for surgery, it is recommended to review pelvic ultrasound every 6-12 months to monitor changes in fibroids. In daily life, you should be careful to avoid long-term use of estrogen-containing health products and keep your weight within a normal range. Supplement appropriate amounts of iron to prevent anemia. If abnormal menstruation or new pelvic compression symptoms occur, you should seek medical evaluation promptly. During the conservative treatment period, traditional Chinese medicine conditioning can be tried, but it must be carried out under the guidance of a professional physician.