Uterine fibroids are the most common benign tumors of the female reproductive system, mostly seen in women aged 30-50, with an incidence rate of 40%-60%. However, most patients with uterine fibroids have no obvious conscious symptoms and are often found by chance during physical examination; a few seek medical attention because of increased menstrual flow, prolonged menstrual period, or symptoms such as frequent urination, constipation, soreness and swelling in the lower back, as well as finding a lump in the lower abdomen on their own. So, how should we treat uterine fibroids? 1. What are the types of fibroids? Are there different symptoms due to different types? Fibroids are classified into 3 types according to the relationship between the growth of fibroids and the uterine muscle wall. The most common type is interstitial fibroids, which are located between the walls of the uterus and surrounded by the muscular layer; the next type is subplasma fibroids, which are located on the surface of the uterus and protrude outward; and the other type is submucosal fibroids, which grow into the uterine cavity. The clinical manifestations of these three types of fibroids in different locations are different. Generally speaking, submucosal fibroids and large interstitial fibroids, which protrude into the uterine cavity or affect the normal structure of the uterine cavity and enlarge the area of the endometrium, often show symptoms of increased menstrual flow, prolonged menstruation, shortened cycles and even anemia; on the other hand, they cause infertility or miscarriage due to deformation of the uterine cavity. The subplasma fibroids and interstitial fibroids that protrude to the surface of the uterus can have no clinical manifestations when they are small in size and are only visible under ultrasound examination; fibroids with huge size can show symptoms such as lower abdominal mass, frequent urination, constipation and lumbosacral pain. 2. How big the fibroids need to be operated? The decision of whether to operate or not should be based on the location, number, size and nature of fibroids. The medical indications for surgery include: uterus enlargement as large as the size of the third trimester (when the uterus is about 11 cm long and a mass in the lower abdomen can be palpated), anemia due to a significant increase in menstrual flow, rapid growth of fibroids on regular review, and exclusion of other factors causing infertility. If surgical treatment is ruled out as necessary, observation and follow-up, gynecologic ultrasound and gynecologic examination every 3-6 months are sufficient. 3. Can fibroids become malignant? Malignancy of fibroids is rare, with an incidence of 0.4%-0.8%, and the actual incidence is even lower. If there are no special symptoms, close follow-up can be done. 4. Which is better: myomectomy or hysterectomy? For those who have fertility requirements, regardless of whether the fibroids are single or multiple, hysterectomy should be performed to preserve the basis of self conception; for those who do not have fertility requirements, whether to preserve the uterus should be considered based on age, personal wishes, size and number of fibroids, etc. Generally speaking, the ovarian endocrine function starts to decline 2 years after hysterectomy, therefore Removal of fibroids has the advantage of preserving anatomy and function. 5. Which is better: open or laparoscopic excision of fibroids? Open surgery can touch almost all fibroids of different sizes and is theoretically more thorough, but there is a possibility of recurrence. Laparoscopic surgery has the advantages of less trauma and faster recovery, but has the disadvantages of relatively longer operation time, no direct touch by the surgeon, possible residual fibroid removal, and postoperative recurrence. The size of the uterus, the number of fibroids, the history of surgery, and the patient’s wishes are all influential factors in choosing the surgical method, where this needs to be treated individually. 6. Do fibroids affect pregnancy? Will fibroids grow when I am pregnant? It is not uncommon for pregnancy to be combined with fibroids, and the two can affect each other. Fibroids that cause deformation of the uterine cavity can lead to infertility, miscarriage and postpartum hemorrhage; large fibroids with low position can obstruct the birth canal and cause abnormal fetal position, resulting in obstructed labor, requiring cesarean section; fibroids in pregnancy or puerperium can degenerate and cause acute abdominal pain, but generally conservative treatment is effective. During pregnancy, the body’s estrogen levels are high and the blood supply to the uterus increases, which can slightly stimulate the growth of fibroids, but they generally do not appear to increase rapidly. In conclusion, it is necessary to do pre-conception counseling and regular maternity check-ups when patients with fibroids are planning to get pregnant. 7. Can fibroids shrink on their own as they age? According to clinical observation, fibroids can shrink on their own after menopause due to the decrease of female sex hormone level, and if they are small in size, they can also disappear gradually. However, if hormone replacement therapy is used during or after menopause, fibroids do not shrink and may even continue to increase in size. If fibroids increase rapidly, prompt medical attention is recommended.