Uterine Fibroids: When Surgery is Necessary - Obstetrics and Gynecology

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Uterine fibroids, also known as leiomyomas, are non-cancerous growths that develop in or on the uterus. They can vary in size, number, and location, and while many women with fibroids experience no symptoms, others may suffer from significant discomfort, heavy menstrual bleeding, or complications such as urinary issues. The decision to undergo surgery for fibroids often depends on several factors, including the severity of symptoms, the size and location of the fibroids, and the patient's reproductive plans.

In your case, it seems that you have been experiencing persistent discomfort and complications, such as urinary tract infections and abnormal bleeding, which can significantly affect your quality of life. While your doctor has recommended waiting until after childbirth to address the fibroids, it is essential to consider the impact these growths are having on your daily life and health.


When is Surgery Necessary?
1. Symptomatic Fibroids: If fibroids are causing severe symptoms, such as heavy menstrual bleeding, pelvic pain, or pressure on the bladder leading to urinary issues, surgery may be warranted. Persistent symptoms that do not respond to medication or other treatments can justify surgical intervention.

2. Size and Location: Fibroids located within the uterine cavity (submucosal fibroids) are more likely to cause heavy bleeding and may be treated with surgery even if the patient has not had children. Conversely, fibroids that are intramural (within the uterine wall) or subserosal (on the outer wall) may be monitored unless they cause significant symptoms.

3. Impact on Quality of Life: If fibroids are significantly affecting your quality of life, such as causing chronic pain or leading to recurrent urinary tract infections, it is reasonable to discuss surgical options with your healthcare provider.


Surgical Options
1. Myomectomy: This is a surgical procedure to remove fibroids while preserving the uterus. It is often recommended for women who wish to retain their fertility. Myomectomy can be performed through various approaches, including laparoscopic (minimally invasive) or open surgery, depending on the size and location of the fibroids.

2. Hysterectomy: In cases where fibroids are large, numerous, or if there are other concerns (such as a desire to avoid future complications), a hysterectomy (removal of the uterus) may be recommended. This procedure eliminates the possibility of fibroids returning but also means that you will not be able to conceive in the future.

3. Uterine Artery Embolization (UAE): This is a minimally invasive procedure that involves blocking the blood supply to the fibroids, causing them to shrink. This option may be suitable for women who do not wish to undergo surgery or preserve their fertility.


Considerations Before Surgery
- Consultation with a Specialist: It may be beneficial to seek a second opinion from a gynecologist who specializes in fibroid treatment. They can provide insights into the best course of action based on your specific situation.

- Discussing Risks and Benefits: Every surgical procedure carries risks, including infection, bleeding, and complications related to anesthesia. Discuss these risks with your doctor, as well as the potential benefits of surgery versus continued conservative management.

- Future Fertility: If you are considering having children in the future, it is crucial to discuss how different surgical options may impact your fertility and any potential implications for future pregnancies.

In conclusion, while your doctor has suggested waiting until after childbirth to address your fibroids, your ongoing symptoms and discomfort warrant a thorough discussion about your options. If your quality of life is significantly affected, it is reasonable to consider surgical intervention sooner rather than later. Always ensure that you are fully informed about the risks and benefits of any procedure and feel comfortable with your treatment plan.