Uterine fibroids are the most common benign tumors of the female reproductive system, with an average of one in every 4-5 people suffering from fibroids. Due to its high incidence, it is a hot issue in the consultation section, and many patients come to us to ask how to treat it? Do I need surgery? What is the best procedure? Can I take medicine to get rid of it? How to prevent it? The cause of fibroids is unknown and may be related to female sex hormones, so there are no clear measures to prevent the occurrence of fibroids. The treatment of fibroids should be decided according to each patient’s age, symptoms, location, size and number of fibroids, which means that the treatment should be individualized. Let’s say the same fibroid of 5cm or even bigger, if it is a patient over 45 years old, without any clinical symptoms, that is, a fibroid is found on physical examination, treatment can be unnecessary and the growth of fibroid can be monitored by ultrasound once every 6 months-1 year. If the fibroid grows fast (normal growth rate is about 1cm/year), ultrasound indicates that the fibroid is rich in blood flow signal, or the fibroid grows to have bladder and rectal compression symptoms such as frequent urination, difficulty in passing stool, or symptoms of increased menstruation, surgery is recommended. If there is no symptom, you can observe until menopause, after menopause, fibroids usually shrink and become smaller or disappear. If the same fibroid grows in a woman of about 30 years old, because her estrogen and progesterone secretion are relatively strong, the fibroid may grow faster, so we tend to treat it actively instead of waiting for the fibroid to grow big and then operate, which will increase the difficulty and surgical trauma. In the same way, if the fibroids grow in the submucosa of the uterus, even if they are small, let’s say only 1 cm, because they cause significant menstrual symptoms, they need to be removed surgically, and hysteroscopic submucosal myomectomy is feasible. Many patients have multiple fibroids, but if the uterus as a whole is not large, the fibroids are not growing fast, and there are no symptoms, they can also be observed and do not need treatment. Can I take Chinese medicine to remove the tumor? I can tell you clearly that no, at least no Chinese medicine has clear efficacy in eliminating fibroids yet. Uterine fibroids can be treated with medication, but there are clear indications. This method is only suitable for near-menopausal women or large fibroids with preoperative medication to shrink the fibroids to reduce surgical trauma, and the medication used is similar to hormonal medication and needs to be taken continuously for 2-3 months. After the medication, menorrhagia and fibroids will shrink, and the fibroids will return to their original size after stopping the medication. Therefore, if someone says that taking Chinese medicine can get rid of fibroids, please don’t be fooled. If fibroids need to be treated surgically, what is the best way to do it? In case of solitary fibroids, even if they are relatively large, as long as they are not particularly large, let’s say the uterus is more than 4 months gestation size, especially in young patients, myomectomy can be performed, provided that the rapid pathology results suggest benign fibroids. In the case of near-menopausal patients, if the patient has a desire to preserve the uterus, and if preoperative tests related to the cervix and endometrium have been performed to exclude malignant lesions, myomectomy is also preferred because the ligaments of the uterus are an important part of the pelvic floor supporting tissues, and removal of the uterus will sever these ligaments and damage the pelvic floor supporting tissues, which will increase the incidence of pelvic organ prolapse. As the demand for quality of life increases, preserving the uterus is also becoming an option for more and more patients and their doctors. Laparoscopic surgery requires a high level of skill and appropriate surgical equipment, so not all hospitals can perform it. Compared with open surgery, laparoscopic surgery is less traumatic, has faster postoperative recovery, significantly reduces postoperative intestinal adhesions and other complications, and avoids poor healing of the abdominal wall incision, so the advantages are obvious. The laparoscopic surgery has been carried out earlier in our hospital, and the technology has become very mature, and most of the fibroids can be removed by laparoscopic surgery. What kind of fibroids need to be removed from the uterus? Multiple fibroids, especially those with fibroids ranging from the size of a grain of rice to more than 10 centimeters, are difficult to remove and will recur soon after surgery, so it is recommended to remove the uterus. Some patients have 4, 5, 7 or 8 fibroids, all small, 2 or 3 cm, how to treat them? Uterine artery embolization can be considered. If the number of fibroids is also large and the size is not too small, let’s say about 5cm, and the patient wants to preserve the uterus, surgical debridement is recommended. With the improvement of surgical techniques, laparoscopic removal of multiple fibroids is not too difficult a procedure. One of my patients who underwent laparoscopic myoma removal a month or so ago came back for a review a week ago, a young mother in her 30s, and had 13 large and small fibroids removed, ranging from 2cm to 6cm in diameter. I’m glad that she made me smell the roses again …… The chance of recurrence after uterine fibroid removal increases with the number of fibroids, averaging about 50%. The risk of recurrence is lower for single fibroids, and only about 1/3 of recurring patients need to be operated on again. If a woman is near menopause, even if she has a recurrence, the risk of re-operation is reduced because the growth of fibroids is generally slower. There is also a concern about the malignancy of fibroids. The chance of malignancy of fibroids, i.e. sarcoma-like degeneration, is low, about 0.4%-0.8%, and it often occurs in older patients, with symptoms such as accelerated growth of fibroids and irregular vaginal bleeding, so patients with fibroids need to consult a doctor promptly if the above symptoms appear. Postmenopausal patients with fibroids still need to be vigilant and have regular reviews to detect abnormalities in time. After reading the above introduction, I believe many patients and friends will have an understanding of their condition and treatment, and relieve some unnecessary worries. I hope my efforts will make you put down your burden and live happily.