Should I have surgery for uterine fibroids?

The article was professionally consulted by Dr. Huynh Thi Hien - Obstetrician and Gynecologist - Department of Obstetrics and Gynecology - Vinmec Nha Trang International Hospital

Uterine fibroids in medical terms are leiomyomas of the uterus. This is a common tumor in women between the ages of 30 and 45. Tumors are influenced by female hormones, enlarge when estrogen is high and gradually shrink when estrogen decreases (menopause). So when do uterine fibroids need surgery?

Most cases of uterine fibroids are small in size, uncomplicated, usually do not need surgery and are followed up periodically 3 - 6 months to re-evaluate tumor status and complications.
In some special cases, patients need endocrine therapy with estrogen antagonists to preserve the uterus for patients who want to have children. Progesterone treatment for cases of tumors with complications of menstrual disorders such as menorrhagia, heavy bleeding but cannot be operated on immediately, is indicated for young patients, not having children or having internal diseases. increases the risk of adverse effects during surgery. These drugs should be used as prescribed by the doctor.

The surgery for uterine fibroids will be very deliberate, depending on the location of the fibroids to decide whether to open surgery or laparoscopic surgery. During surgery, if the bleeding in the uterus cannot be stopped after fibroid removal, it is possible to have a hysterectomy. The problem of getting pregnant later on depends a lot on the results of surgery, in addition to many other factors, including the age of the woman.
Treatment of hysterectomy or fibroid removal is indicated in the following cases:
When the uterine fibroids are large, equivalent to a uterus containing a pregnancy of more than 12 weeks, in this case the tumor can easily cause complications that press on the organs in the abdomen, causing pain and easy degeneration. Surgery when the tumor compresses the ureter, causing hydronephrosis. Surgery when symptoms of menorrhagia, menorrhagia, and hypermenorrhoea persist but endocrine therapy does not improve. Fibroids lead to difficulty getting pregnant, uterine fibroids compress, causing birth defects and even miscarriage. Surgery in case of uterine fibroids located under the mucosa. The tumor is located in the broad ligament. Surgery if malignancy is suspected.

With the development of modern medicine, many methods are applied in uterine fibroid surgery such as: open surgery, conventional laparoscopic surgery and robotic laparoscopic surgery. In which, robotic surgery to remove uterine fibroids is evaluated as the preeminent method in uterine fibroid surgery. Vinmec International General Hospital is the first hospital to deploy robotic surgery in gynecological treatment.

Uterine fibroids are benign tumors, usually not dangerous if detected early. However, many women do not have the habit of going for regular gynecological examinations, so the disease is often detected late, difficult to treat and can cause unwanted complications, especially during pregnancy:
Pregnant women with uterine fibroids The bow is very susceptible to premature birth, abnormal fetal position, placenta attached in an abnormal position (placenta previa, placenta attached to comb teeth). Large uterine fibroids can press on the pelvis, causing pain, pressing on the urinary tract, water retention in the kidneys or pressing on the bladder causing the feeling of always wanting to urinate. Large tumors that make women unable to give birth require a cesarean section and are at higher risk of bleeding or uterine rupture. In the postpartum period, fibroids will shrink and cause no complications, however, sometimes it causes infection, especially for submucosal fibroids. Uterine fibroids can cause infertility by changing the lining of the uterus, making it difficult for an egg to implant at fertilization and can cause repeated miscarriages. Therefore, regular gynecological examination is very important to detect the disease early to intervene and treat in time, avoiding harmful complications.