When there is a need for surgery?

If nonsurgical strategies do not relieve symptoms, surgery may be the best option for treatment.

Surgery may be indicated depending on a number of factors:

Intractable Side Effects.

Surgery may be warranted if fibroids are causing distressing and intractable symptoms that have not been relieved by nonsurgical therapies.

Assuming, however, that symptoms do not pose serious health or life-threatening conditions, a woman should make her own decision based on any factors she deems important (the desire for children, for example).

Enlarging Fibroids.

Rapidly growing fibroids may signify cancer (leiomyosarcoma), which must be ruled out. In postmenopausal women, even slow growth raises suspicions for cancer.

It should be noted, however, that many hysterectomies have been inappropriately performed because of large nonmalignant fibroids that were only suspected to be cancerous.

Women should be sure that diagnostic procedures have been as thorough as possible if they want to avoid an unnecessary hysterectomy.

Severe Anemia from Heavy Bleeding.

When iron supplementation or GnRH agonist therapy fails to resolve anemia and bleeding, major surgery may be recommended (myomectomy or hysterectomy).

Ureteral Obstruction.

Large fibroids sometimes press down on the ureters (the tubes going from each kidney to the bladder), thereby blocking urine from emptying into the bladder. Because ureteral obstructions can permanently damage kidneys, surgery may be indicated.