Uterine fibroids are the most common benign tumors of the female reproductive system. The need to preserve the physiological function of the uterus and the integrity of the body organs is increasingly valued by the general population. As a result, fibroid removal surgery is favored by many young and infertile women. However, with the rise in the number of surgical cases, it is not difficult to find that many patients grow back after the removal of the tumor, which is also known as “recurrence” in medical terms. The recurrence rate after myoma removal surgery reported at home and abroad varies from 20% to 50%. This makes many patients very annoyed, which patients are more prone to recurrence after myomectomy? The following is a combination of scientific research to share with you about the 6 “culprits” of recurrence after myoma resection! The culprit is obesity. Obese patients have a greater body mass index (BMI). Studies have found that the likelihood of postoperative recurrence in patients with BMI ≥ 24 is 2.214 times that of patients with BMI < 24, suggesting that BMI is one of the risk factors for postoperative recurrence. Foreign studies have found a 6% increase in the incidence of leiomyosarcoma for every 1 unit increase in BMI. Excess fat may significantly increase the secretion of estrogen converted from androgens, while at the same time the liver produces less sex hormone-binding globulin, leading to an increase in unbound physiologically functional estrogen in the body, resulting in a relatively hyperestrogenic state that stimulates the growth of leiomyomas and makes them more likely to recur after surgery. The number of fibroids before surgery is one of the risk factors for recurrence after myomectomy. Studies have shown that the number of fibroids before surgery is related to the recurrence rate, and the recurrence rate increases as the number of fibroids removed during surgery increases. The greater the number of myomas found intraoperatively, the more difficult it is to remove them completely, and the more likely they are to remain when they are <0.5 cm in diameter, as they are not identifiable to the naked eye. In addition, the increased number of leiomyomas implies a more severe and widespread myxomatous disease, with a more rapid progression of myxomatous disease compared to those with a small number of leiomyomas. The presence of multiple leiomyosarcomas suggests the presence of high-risk tumorigenic factors or cytogenetic abnormalities at the genetic level, making the patient more likely to develop new leiomyosarcomas. Culprit 3: Age at the time of surgery The results of several domestic studies have confirmed that women aged <40 years are more likely to have recurrence after removal of leiomyosarcoma than women aged >40 years. The reason for this may be the influence of hormone levels in the patient’s body, and related studies also suggest that fibroids are sex hormone-dependent tumors, and the high sensitivity of fibroid tissue to local estrogen is one of the important factors in the development of fibroids. For patients under the age of 40, hormone levels are still in equilibrium. In addition, patients in this age group have higher life and mental stress, and most of them have a diet influenced by the environment and consume more food containing higher hormones, which also promotes the occurrence of fibroids and the recurrence of fibroids after surgery. The level of estrogen in the body of patients over 40 years of age decreases sharply, especially after menopause when the ovaries gradually stop producing estrogen, so that estrogen is maintained at a relatively low level. Therefore, the risk of fibroids in a low hormonal environment decreases with age. Culprit 4: Age of menarche Menarche is the age of first menstruation. Domestic studies have found that the risk of fibroid recurrence is 1.847 times higher in those with menarche age ≤13 years than in those with menarche age >13 years. The main reason is that the higher the level of development before menarche, the earlier the neuro-endocrine regulatory mechanism of sexual maturation of young girls is activated and the earlier menarche arrives. Therefore, early age of menarche is somehow a sign of early arrival of sexual maturity in women, thus becoming a risk factor for recurrence of uterine fibroids, which are closely related to female sex hormones. The actual fact is that the woman who has had her period too early should be followed up closely after having her tumor removed. The epidemiological study found that interstitial fibroids are more likely to recur after surgery than fibroids in other locations. The reason for this is that interstitial fibroids are more deeply embedded in the uterus, which may cause more trauma to the uterus during surgery and deeper sutures, which may increase the risk of recurrence after myomectomy. The study found that non-pregnant patients are more likely to recur after myomectomy than women with a history of pregnancy and childbirth. There is a negative correlation between preoperative pregnancy and fibroid recurrence, and some studies have shown that the incidence of fibroids is twice as high in nulliparous women as in women who have given birth, with a decreasing trend as the number of births increases. Progesterone resists estrogen, and unproductive or fewer births increase the duration of estrogen without progesterone resistance. Therefore, it is more important for women with no previous history of maternity to be aware of the possibility of postoperative fibroid recurrence and to follow up well.