[Medical Q&A] Do all uterine fibroids require surgery? How long after surgery can I prepare for pregnancy?

Planner: Chinese Medical Association

Reviewer: Wang Guixiang, deputy chief physician, Shenzhen Hospital, Cancer Hospital, Chinese Academy of Medical Sciences

Not all patients with uterine fibroids need surgery. Surgical treatment will only be considered when the following three situations occur.

(1) If submucosal uterine fibroids are found before pregnancy, doctors usually recommend surgical treatment. Hysteroscopy is a minimally invasive surgical method that can accurately remove uterine fibroids to reduce possible complications during pregnancy.

(2) If the patient has intramural fibroids accompanied by increased menstrual flow, pelvic pressure (such as frequent urination or difficulty urinating), and after excluding other factors causing infertility or recurrent miscarriage due to intramural fibroids, surgical treatment may be necessary.

(3) Usually when the diameter of uterine fibroids is greater than 4 cm, doctors will recommend that patients remove them before pregnancy.

The interval for preparing for pregnancy after myomectomy depends on the degree of involvement of the uterine myometrium. Clinically, it is routinely recommended to use contraception for 1 to 2 years after myomectomy; those with subserosal or intramural myomas more than 5 mm thick from the endometrium do not need to use contraception, those with intramural myomas 3 to 5 mm from the endometrium should use contraception for 3 to 6 months after surgery, and those with intramural myomas close to the endometrium or that penetrate the uterine cavity during removal should use contraception for 1 year after surgery.