Should I Have My Uterine Fibroid Removed? Key Considerations

Q: Should I Have My Uterine Fibroid Removed? Key Considerations

Hello： The indications for fibroid surgery are as follows： 1. Suspected malignant sarcoma. 2. Menorrhagia, anemia, and inability to improve with medication. 3. Abdominal pain or back pain due to intra-abdominal pressure that cannot be relieved with analgesics.

Should I undergo myomectomy?

Hello, Doctor! I was diagnosed with a 3 cm uterine fibroid over a year ago, and I have been undergoing regular follow-up examinations.
Recently, the fibroid has grown to 6.4 cm.
The doctor has suggested that I undergo a myomectomy while the fibroid is still small, as it would be easier to manage and recovery would be quicker.
However, I am concerned that adhesions after surgery might affect my ability to conceive.
Is the growth of my fibroid considered rapid? Is there a genuine need for removal? If I were to become pregnant first, would the fibroid affect the pregnancy process or fetal development? P.S.
Aside from experiencing menstrual pain on the first and second days of my cycle and having had some mild urinary incontinence in the past, the fibroid has not significantly impacted my life.
Thank you for taking the time to address my concerns despite your busy schedule.

Jiaqi, 30~39 year old female. Ask Date: 2006/10/25

Dr. Li Guanghan reply Obstetrics and Gynecology

Hello: The indications for fibroid surgery are as follows: 1.
Suspected malignant sarcoma.
2.
Menorrhagia, anemia, and inability to improve with medication.
3.
Abdominal pain or back pain due to intra-abdominal pressure that cannot be relieved with analgesics.
4.
Hydronephrosis caused by ureteral compression that cannot be improved with medication.
5.
Urinary or bowel issues due to compression of the bladder or rectum that cannot be alleviated with medication.
6.
Infertility with all tests for both partners being normal, with the only abnormal finding being the fibroid.
7.
Severe anxiety and concern affecting normal life upon learning of the fibroid.
Department of Obstetrics and Gynecology, Hsinchu Hospital.

Reply Date: 2006/10/25

More Info

When considering whether to have your uterine fibroid removed, there are several key factors to evaluate. Uterine fibroids, also known as leiomyomas, are non-cancerous growths in the uterus that can vary in size, number, and location. Your situation, with a fibroid that has grown from 3 cm to 6.4 cm over the course of a year, raises some important considerations.

Growth Rate and Size
The growth rate of your fibroid is a significant factor. Fibroids can grow at different rates, and a rapid increase in size, as you have experienced, may warrant surgical intervention. Generally, if a fibroid is larger than 5 cm, it is often recommended to consider removal, especially if it is symptomatic or continues to grow. The fact that your doctor has suggested surgery while the fibroid is still relatively small indicates a proactive approach to prevent complications that may arise from larger fibroids.

Symptoms and Quality of Life
While you mention that the fibroid has not significantly impacted your daily life aside from mild menstrual pain and occasional urinary incontinence, it is essential to consider potential future symptoms. Larger fibroids can lead to increased bleeding, pelvic pressure, and complications during pregnancy. If you plan to conceive in the future, it is crucial to address any potential issues now, as fibroids can sometimes interfere with implantation or lead to complications during pregnancy.

Surgical Risks and Fertility Concerns
Your concern about potential adhesions (scar tissue) affecting future fertility is valid. Surgical removal of fibroids, particularly through a procedure called myomectomy, can carry risks of adhesions. However, skilled surgeons often use techniques to minimize this risk. It is essential to discuss these concerns with your healthcare provider, who can explain the specific surgical techniques they would use and the associated risks.

Impact on Pregnancy
If you choose to become pregnant before addressing the fibroid, it is important to note that while many women with fibroids have successful pregnancies, there can be risks involved. Fibroids can potentially cause complications such as placental abruption, preterm labor, or changes in fetal position, which may lead to a cesarean delivery. The size and location of the fibroid are critical factors in determining the potential impact on pregnancy.

Conclusion
In summary, the decision to remove a uterine fibroid should be based on several factors: the growth rate and size of the fibroid, your current symptoms and quality of life, potential risks associated with surgery, and your future fertility plans. Consulting with a gynecologist who specializes in fibroid treatment can provide you with tailored advice based on your specific situation. They can help you weigh the benefits of surgery against the risks and help you make an informed decision that aligns with your reproductive goals and overall health.
Ultimately, while the fibroid's current impact on your life may be minimal, its growth and potential future complications make it a topic worth discussing thoroughly with your healthcare provider.

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