Is it better to remove all uterine fibroids or to keep the uterus?

Whether it is better to completely remove the uterus or to keep the uterus requires comprehensive consideration based on the patient's age, clinical symptoms, whether there is a desire to have children, the location of the uterine fibroids, the condition of the cervix, etc. If the patient is young, has a desire to have children, hopes to retain reproductive function, and has no abnormalities in cervical cancer screening, uterine fibroid removal surgery can be considered, that is, it is better to keep the uterus. Otherwise, it is better to have a total hysterectomy. The specific analysis is as follows:

1. Age: It is generally better for young patients to retain their uterus. For women near menopause, if their clinical symptoms are severe after conservative treatment, they may need a hysterectomy.

2. Clinical symptoms: If only compression symptoms occur and have little effect on menstruation, uterus-preserving surgery can be performed; if compression symptoms occur and are accompanied by heavy menstrual flow and blood clots, the patient's condition has been long-term and accompanied by anemia, and drug treatment is ineffective, a total hysterectomy is required.

3. Whether there is a desire to have children: For young women who want to have children, myoma removal should be performed first and the uterus should be preserved. For patients who do not want to have children and have severe clinical symptoms, total hysterectomy can be performed.

4. Location of uterine fibroid growth: Uterine fibroids are located under the serosa and exert less pressure on the uterine cavity, so myomectomy can be performed; uterine fibroids grow in the myometrium and compress the endometrium, causing increased menstrual flow. If drug treatment is ineffective, total hysterectomy can be performed.

5. Cervical condition: Cervical cytology examination is performed before surgery to exclude cervical intraepithelial lesions such as cervical cancer. Myomectomy can be performed if there is no abnormality in the cervical examination. If the cervical examination finds suspicious cervical cancer, a total hysterectomy is required.

After a total hysterectomy, the patient will not have menstruation and will not have fertility. In addition, because hysterectomy affects the secretion of ovarian hormones, the patient is likely to enter menopause earlier. Therefore, total hysterectomy should be carefully considered for young patients, unless there is a possibility of endometrial malignancy or suspected cervical malignancy.

Patients with uterine fibroids need to seek medical attention in a timely manner and discuss surgical methods with their doctors based on their own conditions and illness.