Indications for surgery for uterine fibroids

Indications for surgery of uterine fibroids mainly include compression symptoms caused by excessive fibroids, anemia caused by abnormal uterine bleeding, rapid growth of fibroids suspected of malignant transformation, infertility or recurrent miscarriage, and ineffective drug treatment.

Fibroids exceeding 5 cm in diameter or compressing the bladder and rectum causing symptoms such as frequent urination and constipation are clear indications for surgical intervention. Such patients will experience a feeling of distension in the lower abdomen, increased frequency of urination and residual urine, and difficulty in defecation may be accompanied by distension in the anus. At this time, you can choose laparoscopic myomectomy or laparotomy. The former is less invasive but suitable for cases with a small number of fibroids and superficial locations, while the latter is suitable for cases with multiple fibroids or special locations.

Abnormal uterine bleeding causing moderate to severe anemia requires surgical intervention. Patients have significantly increased menstrual flow accompanied by blood clots, hemoglobin may be lower than 80g/L, and may have signs of anemia such as dizziness and fatigue. For anemia that is unresponsive to medical treatment, uterine artery embolization or hysterectomy can be chosen. The former preserves the uterus but carries the risk of recurrence, while the latter completely solves the problem but loses reproductive function.

If the volume of fibroids increases by more than 50% of the original volume in a short period of time or if they continue to grow after menopause, you need to be alert to the possibility of sarcomatoid transformation. Such patients should undergo enhanced MRI to evaluate blood flow signals. After diagnosis, extrafascial total hysterectomy plus bilateral adnexectomy is required. Tumor markers and imaging examinations need to be closely followed up after surgery.

After excluding other factors, infertile patients can consider hysteroscopic or laparoscopic myomectomy if it is confirmed that the fibroid is compressing the fallopian tube or the uterine cavity is deformed and hinders the implantation of the fertilized egg. Care must be taken to protect the integrity of the endometrium during the operation. It is recommended to wait for more than 1 year before trying to get pregnant after the operation to reduce the risk of uterine rupture.

For perimenopausal patients who have completed childbearing and have obvious symptoms, hysterectomy may be an option if drug control is not effective. Older patients may consider having their fallopian tubes removed at the same time to reduce the risk of ovarian cancer, but the need for hormone replacement therapy needs to be fully evaluated.

After diagnosis of uterine fibroids, ultrasound should be reviewed every 3-6 months to monitor changes, and a regular schedule should be maintained to avoid fluctuations in estrogen levels. Pay attention to controlling the intake of animal fat in the diet, and appropriately supplement vitamin D and antioxidant foods. If you experience symptoms such as prolonged menstruation, enlarged lower abdominal mass, or difficulty in urination and defecation, you need to seek medical attention promptly. Avoid strenuous exercise and abdominal massage to prevent torsion of fibroids or secondary bleeding.