Uterine fibroids are common benign diseases in gynecology. Clinically, fibroids often manifest as heavy menstrual flow, anemia, pelvic masses, lower abdominal pain, frequent urination, constipation and other symptoms, while some are asymptomatic. So how exactly should uterine fibroids be treated? To understand this problem, let’s start with the classification of fibroids. Uterine fibroids are classified into subplasmic fibroids, interstitial fibroids and submucosal fibroids according to their growth sites. Subplasmalemmal fibroids grow outside the uterine cavity, mostly on the outer surface of the uterus, and are easily recognizable as locally raised. Interstitial myomas, as the name implies, grow within the myometrium, so small interstitial myomas are located deep within the myometrium with no obvious elevation on the uterine surface and therefore are not easily detected laparoscopically. Submucosal fibroids grow mainly convexly towards the uterine cavity, where some or most of them are located, and often cause increased menstrual flow. Which fibroids require surgery? Generally speaking, fibroids are slow growing and if there are no symptoms as mentioned above, they can be treated without treatment and regular review (once every 6-12 months) is sufficient. If there are symptoms such as heavy menstrual flow, anemia, stomach pain, frequent urination, etc., then treatment is needed. For submucosal fibroids, conservative and pharmacological treatment is often not effective and hysteroscopic electrosurgery is required to remove the fibroids. Subplasmalembranous and interstitial fibroids are then removed by open or laparoscopic surgery. Usually, for multiple fibroids with more than 3, open excision is recommended, because it is palpable and reduces the chance of missing fibroids, especially for women who wish to have another child, and the risk of uterine rupture after open excision of fibroids and subsequent pregnancy is significantly reduced. For single, small fibroids, laparoscopy is superior with its advantages of beautiful abdominal wall, less disturbance to the gastrointestinal tract and faster recovery. However, laparoscopic resection of fibroids also carries the risk of myoma dissemination during fragmentation (about 1/400) and, in the case of uterine sarcoma (another malignant tumor of the uterus), of implantation and metastasis. Uterine fibroids are usually benign and rarely become malignant, but unfortunately fibroids and uterine sarcomas are difficult to identify before surgery, so fibroids should be reviewed regularly and extra vigilance should be exercised for faster growing fibroids that increase in size in a short period of time. Which type of surgery can remove fibroids? Even if the fibroids that are visible to the naked eye and palpable to the hand are removed, some of them may be missed because they are too deep or too small. As long as the fibroids do not grow too big before menopause, there is no need to operate again, and most of the fibroids shrink after menopause, so it is OK to observe them. How big is a fibroid that requires surgery? It is generally accepted that if the fibroids do not exceed 125 px in diameter and the size of the uterus does not exceed 10 weeks of gestation, surgery may be suspended. Even if they are beyond these limits, if they are asymptomatic, they can be closely followed and observed, and if they are found to be growing rapidly within a short period of time, they will need to be removed surgically. If a patient with fibroids is planning to get pregnant, should she get pregnant first or have surgery first? With the advent of the second child era, more and more patients with fibroids are also faced with the dilemma of getting pregnant again. This issue needs to be analyzed on a case-by-case basis. On the one hand, it is related to the growth site and size of the fibroid, and on the other hand, it needs to be combined with the patient’s age, pregnancy and childbirth history and other factors. If the fibroid is a subplasmalemmal fibroid, the size of the fibroid is not important and it does not affect the morphology of the uterine cavity and does not cause embryonic arrest, fetal growth restriction, premature delivery or miscarriage, so you can get pregnant first. If the fibroid is a submucosal fibroid, the fibroid must be treated first, otherwise it will affect the pregnancy. If the myoma is growing between the muscle walls, the situation is more complicated. If the fibroid is in the cervical area, it may prevent the fetus from descending, cause poor contraction of the lower part of the uterus during delivery, and cause more bleeding. Secondly, if the fibroids exceed 125px, they may squeeze the uterine cavity and cause deformation, which may lead to miscarriage, embryonic abortion, premature birth, and fetal growth restriction. As for “how long it takes to get pregnant again after surgery”, it depends on the site of the fibroids and the surgery method, and it usually takes six months to two years to prevent pregnancy. Thirdly, if the number of fibroids is large and not very large, it does not affect pregnancy much. If the patient is older, the problem of fibroids can be considered after the completion of childbirth.