Uterine Fibroids: Should I Have Surgery?

Uterine fibroids are growths in or on the uterus. They are not cancer. Fibroids can grow on the inside of the uterus , within the muscle wall of the uterus , or on the outer surface of the uterus . They can change the shape of the uterus as they grow. This can make it hard for you to get pregnant.

Over time, the size, shape, location, and symptoms of fibroids may change.

As women get older, they are more likely to have uterine fibroids, especially from their 30s and 40s until menopause. Most have mild or no symptoms. But fibroids can cause bad pain, bleeding, and other problems.

The cause of fibroids is not known. But the hormones estrogen and progesterone can make them grow. A woman's body makes the highest levels of these hormones during her childbearing years. After menopause, when hormone levels decrease, fibroids often shrink or disappear.

Uterine fibroids usually need treatment when they cause:

• Anemia from heavy fibroid bleeding.
• Ongoing low back pain or a feeling of pressure in the lower belly.
• Trouble getting pregnant.
• Problems during pregnancy, such as miscarriage or preterm labor.
• Problems with the urinary tract or bowels.
• Infection, if the tissue of a large fibroid dies.

Depending on the reasons you need treatment, one type of treatment may work better for you than another.

Myomectomy, which is surgery to take out just the fibroids, can decrease pain and other symptoms. It also may make it possible for you to get pregnant.

Surgery can be done:

• Through the vagina and into the uterus using a lighted scope.
• Through a large cut in the belly.
• Through several small cuts in the belly using a lighted scope. This is called a laparoscopy.

How well myomectomy works

Taking out fibroids decreases menstrual bleeding and pelvic pain from fibroids. It may improve your chances of having a baby.

Chance that fibroids can come back

Fibroids tend to grow back, unless you have your uterus taken out. New fibroids also can grow. Fibroids return in up to half of women who have surgery to take out just the fibroids. They are more likely to come back if you had many fibroids.¹ Talk to your doctor about whether your type of fibroid is likely to grow back.

Risks of myomectomy

Cutting into the uterine wall during this surgery can cause problems in a future pregnancy. There could be a problem with the way the placenta grows, such as placenta abruptio or placenta accreta. During labor, the uterus might not work like it should. This could mean that you would need a cesarean delivery.

Hysterectomy, which is surgery to take out the uterus, cures fibroids. But it's usually the last choice for treatment, because it's major surgery and it makes you unable to get pregnant. Having this surgery means that you will no longer have menstrual periods. The ovaries and fallopian tubes also may be taken out at the same time.

This surgery gives most women relief from their symptoms.

Talk to your doctor if you are not close to menopause (about age 50) and you're thinking about having your uterus and ovaries taken out. Experts say that women live longer when they keep their ovaries until at least age 65. This may be because women who have their ovaries have fewer hip fractures and are less likely to get heart disease.²

How well hysterectomy works

This surgery:

• Relieves pain from fibroids.
• Stops anemia from heavy and irregular vaginal bleeding.
• May fix leakage of urine if it was caused by fibroids.

Chance that fibroids can come back

Fibroids do not grow back after your uterus is taken out.

Risks of hysterectomy

Most women don't have problems from this surgery. But possible long-term problems include:

• Scar tissue that can cause pelvic pain.
• Early menopause caused by a slow, early decline of the ovaries.
• Weakness of the pelvic muscles and ligaments that support the vagina, bladder, and rectum. This can cause bladder or bowel problems.
• Trouble urinating.
• Pelvic pain. If you had pain before surgery, taking out your uterus may not relieve your pain.

Most women do not have problems after either surgery to treat fibroids. But problems can include:

• A fever. A slight fever is common after any surgery.
• Rare problems, such as:
  • Infection.
  • Blood clots in the legs or lungs.
  • Scar tissue (also called adhesions).
  • Injury to other organs, such as the bladder or bowel.
  • A collection of blood at the surgical site.
  • Continued heavy bleeding. Some vaginal bleeding within 4 to 6 weeks after you have the uterus removed is normal.
  • Problems from the medicine used to make you sleep during surgery.
  • Severe blood loss that causes you to need more blood (transfusion).

Your doctor might suggest that you have surgery to take out just your fibroids if:

• You want to treat your fibroids in a way that may make it possible for you to get pregnant later.

Your doctor might suggest that you have surgery to remove your uterus if:

• You have bad symptoms and:
  • Other treatments have not helped.
  • You're not near menopause.
  • You don't plan to have children (or more children).
  • There is a risk of cancer.