Uterine fibroids, known as the “first tumor of gynecology”. It is estimated that the incidence of fibroids in women of childbearing age is at least 20-25%. It is believed that many women are suffering from fibroids: What are fibroids? Do they need to be treated? How to treat it? Does it affect pregnancy? Uterine fibroids are benign tumors formed by the proliferation of smooth muscle tissue in the uterus. According to the relationship between the fibroids and the uterine wall, there are three main types of fibroids: (1) interstitial fibroids: the most common, the fibroids are located between the uterine wall. (2) Subplasma leiomyoma: the leiomyoma protrudes from the surface of the uterus. (3) Submucosal leiomyoma: the leiomyoma grows towards the uterine cavity and protrudes from the uterine cavity. There are also fibroids that grow in special places such as cervical fibroids and broad ligament fibroids. Uterine fibroids can be multiple or multiple types of fibroids growing on the same uterus at the same time. Most fibroids have no obvious symptoms and are often found unintentionally during a physical examination. The severity of symptoms and the presence or absence of symptoms depend on the location, size, number and degeneration of fibroids. The main symptoms are: (1) increased menstrual flow and prolonged periods: this is the most common symptom of uterine fibroids. It is seen in large interstitial myoma and submucosal myoma. Long-term increased menstrual flow may lead to anemia. (2) Lower abdominal mass: fibroids can be felt in the lower abdomen when they grow to a certain extent. Submucosal fibroids can be detected by protruding from the vaginal opening. (3) Increased leukorrhea: Large interstitial fibroids may increase leukorrhea. Symptoms such as abnormal leucorrhea and vaginal discharge may also occur in cases of submucosal fibroids with infection or necrosis. (4) Compression symptoms: The bladder is in front of the uterus, and when the anterior wall fibroids are large, they can compress the bladder and cause frequent urination. The fibroids in the cervix can compress the urethra causing difficulty in urination. The posterior wall of the uterus is the rectum, and fibroids in the posterior wall can cause lower abdominal cramping and constipation. (5) Others: Uterine fibroids are usually painless, but acute lower abdominal pain, vomiting, and fever may be present when red degeneration of fibroids (a kind of degeneration of fibroids, commonly seen during pregnancy and after delivery) occurs. Acute abdominal pain can occur when the subplasmalemma is twisted at the tip (when there is a sudden change in position, such as during exercise, sex, etc.). It can also cause infertility or miscarriage when the deformation of the uterine cavity is more severe. There are several ways to treat uterine fibroids: (1) Observation: Asymptomatic fibroids generally do not require treatment, especially in women who are approaching menopause. This is because most fibroids can shrink after menopause. It can be reviewed every 3-6 months to observe whether there is any change in the fibroids and whether symptoms appear. (2) Drug treatment: Suitable for those with mild symptoms, near menopause and not suitable for surgery. The main drug is gonadotropin-releasing hormone analogue (GnRH-a, Chinese name is XX Relin) which can lower the estrogen level to post-menopause to relieve the symptoms and inhibit the growth of fibroids. However, the fibroids can continue to grow after stopping the drug. It is mainly used to shrink fibroids before surgery to facilitate surgery, and to avoid surgery in near-menopausal women who are transitioning to natural menopause early. It is usually used for 3-6 months and injected subcutaneously once a month. However, symptoms associated with menopausal syndrome may occur with long-term use and can be relieved by adding estrogen in reverse in severe cases. (3) Surgery: The following patients are suitable for surgery: excessive menstruation leading to secondary anemia and ineffective medication; severe abdominal pain and acute abdominal pain; large fibroids with compression symptoms; fibroids can be identified as the sole cause of infertility or miscarriage; fibroids are growing too fast and malignancy is suspected (the probability of fibroid malignancy is very low, <0.5%). The procedure can be performed transabdominally (open or laparoscopic) or transvaginally (hysteroscopic, for submucosal fibroids). Myomectomy, subtotal hysterectomy (preserving the cervix) and total hysterectomy (either transabdominal or transvaginal) can be performed. Recurrence is still possible after myomectomy, with a recurrence rate of nearly 50%, of which perhaps 1/3 of patients still require surgery. (4) Others: mainly uterine artery embolization and high-intensity ultrasound focused ablation (commonly known as HEFA), which are less commonly used at present. Since uterine fibroids mostly occur in women of childbearing age, we all have more or less the same question: do uterine fibroids affect pregnancy? This needs to be analyzed on a case-by-case basis. For small fibroids, especially small interstitial fibroids, they usually have no effect on pregnancy and can be prepared and conceived normally; for fibroids that are ≥4 cm in diameter, it is recommended to remove them before pregnancy; for submucosal fibroids, it is also recommended to remove them before pregnancy because they can affect the morphology of the uterine cavity and can easily lead to miscarriage and infertility during pregnancy. As far as the surgical procedure is concerned, open surgery is preferred for women with fertility requirements, as it allows for a more secure closure of the uterine incision and reduces the risk of uterine rupture after pregnancy. What should be done if a patient with fibroids is pregnant or if fibroids are detected during pregnancy? In general, pregnancy may cause fibroids to increase in size and degenerate easily due to increased levels of estrogen and progesterone, which increases the rate of obstructed labor, cesarean delivery and preterm delivery. If fibroids develop symptoms (such as pain, fever, nausea and vomiting) during pregnancy due to degeneration, the majority of patients can be relieved with conservative treatment. Should a pregnant woman with fibroids have a cesarean delivery? This also depends on the size and location of the fibroids and the condition of the mother and child. If the fibroids are small, they usually do not affect the progress of labor and can be considered for normal delivery; if the fibroids are located in the cervix, lower part of the uterus, placenta attachment, etc., they will affect the progress of labor and a cesarean section should be performed. If a cesarean section is performed, is it necessary to remove the fibroids at the same time? Generally speaking, small fibroids located on the surface of the uterus can be removed during cesarean delivery. For multiple, large, deep, and special areas of fibroids, removal during cesarean delivery is not recommended.