Surgery is the most effective way to treat fibroids. However, not all fibroids are suitable for surgery. If the fibroids are small and do not cause any obvious symptoms, surgery can be withheld and the fibroids can be reviewed regularly for changes. In general, patients with fibroids greater than or equal to 5 cm in diameter need surgery to remove the fibroids. However, fibroids located in the mucosa of the uterus may cause excessive menstrual flow and infertility due to their protrusion into the uterine cavity, so surgery is best to remove them according to their symptoms. The current medical indications for surgery include: 1) excessive menstruation or secondary anemia caused by fibroids, and medication is ineffective; 2) severe abdominal pain, painful intercourse or chronic pain caused by fibroids; 3) large size of fibroids that cause frequent urination, difficulty urinating and constipation due to compression of the bladder and rectum; 4) infertility or recurrent miscarriage caused by fibroids; 5) possible malignancy of fibroids. The size of fibroids is not used as an indication for surgery. The decision is mainly based on the clinical symptoms and the location and nature of fibroids, and the patient’s requirements for fertility are also taken into consideration. For women with no fertility requirements and no clinical symptoms, there is no indication for surgery for fibroids of any size, which is the consensus of clinicians at this stage. Generally speaking, fibroids shrink and become smaller after menopause, but if they increase in size instead of getting smaller after menopause, we should be alert to the malignancy of fibroids and surgery is preferred.