At what age do uterine fibroids need surgical removal?

Surgical removal is usually recommended when uterine fibroids are larger than 50 mm in diameter or cause severe symptoms. Whether surgery is needed is related to factors such as the location of the fibroids, their growth rate, and the severity of their symptoms.

Uterine fibroids are common benign tumors, and whether they require surgical treatment depends on many aspects. When the diameter of the fibroid is between 30-50 mm, if it does not cause symptoms such as heavy menstruation, severe abdominal pain, frequent urination and urgency, conservative treatment is generally given priority. At this time, you can observe the changes in fibroids through regular follow-up, and use gonadotropin-releasing hormone analogues such as leuprolide injections to suppress hormone levels, or compound oral contraceptives to regulate the menstrual cycle. When the diameter of fibroids exceeds 50 mm, the larger size may compress surrounding organs, causing difficulty in urination and defecation, and discomfort in the lumbosacral region. In such cases, surgical intervention is recommended. Even if fibroids in special locations, such as submucosal fibroids, are small in size, if they cause abnormal uterine bleeding and lead to anemia, hysteroscopic myomectomy needs to be considered.

For young women who want to have children, individualized evaluation is required even if the fibroids meet the indications for surgery. When subserosal fibroids grow outward and do not affect the shape of the uterine cavity, pregnancy with tumors of 40-60 mm can be attempted under close monitoring. However, if intramural fibroids protrude into the uterine cavity and cause recurrent miscarriage, laparoscopic or open myomectomy may be required. If fibroids in pre- and postmenopausal women increase rapidly or abnormally bleed within a short period of time, the possibility of malignant transformation needs to be ruled out regardless of size. Under special circumstances, although the fibroids are not large in size, they are also indicated for surgery when they are combined with severe anemia, pain that is ineffective in drug treatment, or when degeneration of the fibroids causes an acute abdomen.

It is recommended that patients with uterine fibroids have a re-examination with ultrasound every 6-12 months to monitor changes in the fibroids, and avoid strenuous exercise during menstruation to aggravate bleeding. The daily diet can include an appropriate amount of cruciferous vegetables such as broccoli, which contains indole-3-carbinol, which may help regulate estrogen metabolism. If you experience shortened menstrual cycles, prolonged menstrual periods or non-menstrual bleeding, you should seek medical attention as soon as possible. Doctors will develop personalized treatment plans based on age, symptoms and fertility needs. If necessary, minimally invasive methods such as uterine artery embolization and focused ultrasound ablation can be used to replace traditional surgeries.