Uterine fibroids are a common clinical condition, and the incidence of fibroids in women of childbearing age is about 20% to 40%. Uterine fibroids are generally benign lesions, and only very rarely are malignant lesions (uterine sarcoma). Do I need surgery to treat fibroids? What kind of surgery is best? Is interventional therapy and medication effective? These questions are often the most important for patients.
A. Most patients with fibroids do not need surgery, but surgery is best if they have the following conditions
1, large or numerous fibroids, specifically, single fibroids larger than 5cm in diameter, or multiple fibroids.
2. Those with clinical symptoms, such as heavy menstrual flow, menstrual cycle disorders, pain, pressure symptoms (frequent urination, constipation).
3.Increased fibroids within a short period of time.
4.With cervical lesions.
B. Those who are approaching menopause (age >45) and have no obvious symptoms can be conservatively observed and do not need urgent surgical treatment. However, if the fibroids are large or symptomatic, it is better to perform surgical removal.
C. Uterine fibroids can be treated with interventions and drugs (GnRHa, mifepristone, endometrium, Chinese medicine), but the results are poor. It can only be used as a complementary treatment before or after surgery, or a palliative treatment due to physical condition that cannot tolerate anesthesia or surgery.
D. Surgical methods include open myomectomy, hysteroscopic submucosal myomectomy, hysterectomy, minimally invasive laparoscopic myomectomy and laparoscopic hysterectomy. In principle, laparoscopic surgery has a tendency to replace open surgery. Laparoscopic hysterectomy has the same contraindications as open surgery. There are some cases in which laparoscopic myomectomy is contraindicated.
1, myoma greater than 7 cm in diameter or uterus enlarged for more than 3 months.
2, fibroids in the posterior wall of the uterus.
3.Interstitial fibroids near the endometrium.
4.Multiple myomas.
E. Do people get older after hysterectomy? Will it affect sex life?
Many people worry that ovarian function will fail prematurely after hysterectomy and that people will become old, but this is not true. The blood vessels supplying the ovaries mainly rely on the ovarian arteries, which produce and release female hormones, and hysterectomy has a slight effect on human hormones. Hysterectomy does not cause vaginal shortening and therefore does not affect sexual life. However, it may have psychological effects on some patients.
F. How to treat submucosal fibroids
Submucosal fibroids can cause increased menstrual flow, prolonged menstruation, and affect the embryo’s implantation and lead to infertility or miscarriage. Therefore, submucosal fibroids should be treated regardless of their size. The best method is hysteroscopic electrosurgery of fibroids.
G. Pregnancy after fibroid surgery
Whether open or laparoscopic myomectomy is performed, it is helpful for pregnancy. If the fibroid is located between the muscle walls, postoperative contraception is recommended for more than 1 year to avoid uterine rupture due to poor healing of the uterine wall. Cesarean section is recommended for this type of patient delivery. There are no special requirements for postoperative pregnancy for subplasmic myomas or submucosal myomas.
H. Those methods of interventional treatment for uterine fibroids
Radiofrequency treatment: Electrodes are inserted into the fibroids through the abdominal wall or vagina under ultrasound, and the fibroids are ablated through thermal damage.
High-frequency focused ultrasound knife: Through ultrasound positioning, local heat energy is released to ablate fibroids.
MTX intramyocardial injection: Through ultrasound or hysteroscopy, the chemotherapeutic drug MTX is injected into the myoma tumor to cause myoma necrosis.
Uterine artery embolization therapy: Through femoral artery cannulation to the internal iliac artery or uterine artery bilaterally, an embolic agent is injected to cause local blood supply interruption and myoma degeneration and necrosis.
I. Scientific treatment of patients with uterine fibroids must follow the principle of individualized treatment. Judgment is made based on the size of the patient’s fibroid, presence or absence of symptoms, age, fertility requirements, and the condition of the cervix and endometrium. If the fibroids are small, asymptomatic, or near menopause, observation and conservative medication are recommended; if the fibroids are large, multiple, with obvious symptoms (heavy menstruation, long periods causing anemia, obvious pressure symptoms, obvious enlargement in a short time, submucosal fibroids, those affecting pregnancy (infertility, miscarriage), bleeding and degeneration of fibroids, etc., early surgery is preferable. The procedure should not be forced, but should be decided after full communication with the doctor. In the case of small submucosal fibroids, hysteroscopic myomectomy is definitely the best. In the case of subplasma fibroids, laparoscopic myomectomy is the best surgical procedure. Patients with uterine prolapse should prefer a femoral hysterectomy. Whether myomectomy or hysterectomy should be performed must be determined according to the patient’s specific situation, and it is not possible to say which one is better.
J. As for the question of whether the fibroid will recur after surgery, no one can guarantee that the fibroid will not recur. It’s as simple as people get sick when they are alive. Most fibroids are hormone-dependent and easy to get at childbearing age. However, there are a small number of fibroids that are not related to sex hormones. Clinically, I have seen a 10-year-old girl who has not yet had her period and has a huge fibroid growing on her uterus. Postmenopausal women also have a history of fibroid growths. However, these are, after all, rare cases and are small probability events.