Uterine Fibroids: Should I Have Surgery?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Uterine Fibroids: Should I Have Surgery?
Get the facts
- Have surgery to take out just your fibroids or to take out your uterus.
- Don't have surgery. You can have a procedure called fibroid embolization or take hormones (GnRH-a) to shrink fibroids. You also can take over-the-counter medicines for pain or get a certain type of intrauterine device (IUD) to reduce cramping and bleeding.
This decision aid is for women who have decided to treat their uterine fibroids. Many fibroids do not need treatment.
Key points to remember
- You might want to choose surgery if fibroids are making it hard for you to get pregnant or if you have other symptoms that affect your quality of life, and other treatments have not worked for you. There are two surgical treatments for fibroids: taking fibroids out of the uterus (myomectomy) and removing the uterus (hysterectomy).
- After menopause, fibroids usually get smaller or go away. If you are close to menopause, you could take nonsteroidal anti-inflammatory drugs (NSAIDs) (such as ibuprofen or naproxen) for pain or have fibroid embolization. You also could get a certain type of IUD or take hormone therapy (GnRH-a) for a short time if you have bad symptoms.
- If you want to have a baby, taking out just the fibroids may improve your chance of getting pregnant and reduce your chance of having a miscarriage. But this type of surgery can lead to a problem with the placenta. It also can make a cesarean delivery more likely.
- Taking out the uterus is the only cure for uterine fibroids. But it's not a good choice if you want to have children (or more children). You can't get pregnant after your uterus is taken out.
- Both types of surgery have short-term risks, such as blood loss and infection. Both surgeries also can cause scar tissue, which can cause pelvic pain and infertility.
Uterine fibroids are growths in or on the uterus. They are not cancer. Fibroids can grow on the inside of the uterus, within the muscle wall of the uterus, or on the outer surface of the uterus. They can change the shape of the uterus as they grow. This can make it hard for you to get pregnant, or it can cause problems during a pregnancy.
Over time, the size, shape, location, and symptoms of fibroids may change.
As women get older, they are more likely to have uterine fibroids, especially from their 30s and 40s until menopause. Most have mild or no symptoms. But fibroids can cause bad pain, bleeding, bowel blockage, and other problems.
The cause of fibroids is not known. But the hormones estrogen and progesterone can make them grow. A woman's body makes the highest levels of these hormones during her childbearing years. After menopause, when hormone levels decrease, fibroids often shrink or disappear.
Uterine fibroids usually need treatment when they cause:
- Anemia from heavy fibroid bleeding.
- Ongoing low back pain or a feeling of pressure in the lower belly.
- Trouble getting pregnant because a fibroid changes the shape of the uterus or the location of the fallopian tubes.
- Problems during pregnancy, such as miscarriage or premature labor.
- Blockage of the urinary tract or bowels.
- Infection, if the tissue of a large fibroid dies.
Depending on the reasons you need treatment, one type of treatment may work better for you than another.
Myomectomy, which is surgery to take out just the fibroids, can decrease pain and other symptoms. It also may make it possible for you to get pregnant. This surgery also may improve your chances of having a healthy pregnancy after treatment.
Surgery can be done:
- Through the vagina and into the uterus using a lighted scope.
- Through a large cut in the belly.
- Through several small cuts in the belly using a lighted scope. This is called a laparoscopy.
How well myomectomy works
Taking out fibroids decreases menstrual bleeding and pelvic pain from fibroids. It is the only treatment that may improve your chances of having a baby.1 Some studies suggest that taking out fibroids before you get pregnant also may reduce the risk of a miscarriage.1
Chance that fibroids can come back
Fibroids tend to grow back, unless you have your uterus taken out. New fibroids also can grow. Fibroids grow back in up to half of women who have surgery to take out just the fibroids. They are more likely to come back if you had many fibroids.2 Talk to your doctor about whether your type of fibroid is likely to grow back.
Risks of myomectomy
Cutting into the uterine wall during this surgery can cause problems in a future pregnancy. There could be a problem with the way the placenta grows, such as placenta abruptio or placenta accreta. During labor, the uterus might not work like it should. This could mean that you would need a cesarean delivery.
If you want to get pregnant, surgery through one large cut may be safer than surgery through several small cuts. There have been a few reports of the uterus rupturing during pregnancy after surgery with several small cuts.1
Hysterectomy, which is surgery to take out the uterus, cures fibroids. But it's usually the last choice for treatment, because it's major surgery and it makes you unable to get pregnant. Having this surgery means that you will no longer have menstrual periods. The ovaries and fallopian tubes also may be taken out at the same time.
This surgery gives most women relief from their symptoms.
Talk to your doctor if you are not close to menopause (about age 50) and you're thinking about having your uterus and ovaries taken out. Experts say that women live longer when they keep their ovaries until at least age 65. This may be because women who have their ovaries have fewer hip fractures and are less likely to get heart disease.3
How well hysterectomy works
- Relieves pain from fibroids.
- Stops anemia from heavy and irregular vaginal bleeding.
- May fix leakage of urine if it was caused by fibroids.
Chance that fibroids can come back
Fibroids do not grow back after your uterus is taken out.
Risks of hysterectomy
Most women don't have problems from this surgery. But possible long-term problems include:
- Scar tissue that can cause pelvic pain.
- Early menopause caused by a slow, early decline of the ovaries.
- Weakness of the pelvic muscles and ligaments that support the vagina, bladder, and rectum. This can cause bladder or bowel problems.
- Trouble urinating.
- Pelvic pain. If you had pain before surgery, taking out your uterus may not relieve your pain.
Most women do not have problems after either surgery to treat fibroids. But problems can include:
- A fever. A slight fever is common after any surgery.
- Rare problems, such as:
- Blood clots in the legs or lungs.
- Scar tissue (also called adhesions) that can cause pelvic pain and infertility.
- Injury to other organs, such as the bladder or bowel.
- A collection of blood at the surgical site.
- Continued heavy bleeding. Some vaginal bleeding within 4 to 6 weeks after you have the uterus removed is normal.
- Problems from the medicine used to make you sleep during surgery.
- Severe blood loss that causes you to need more blood (transfusion).
Your doctor might suggest that you have surgery to take out just your fibroids if:
- You want to treat your fibroids in a way that may make it possible for you to get pregnant later.
Your doctor might suggest that you have surgery to remove your uterus if:
- You have bad symptoms and:
- Other treatments have not helped.
- You're not near menopause.
- You don't plan to have children (or more children).
- There is a risk of cancer.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You may take the hormone GnRH-a before surgery to shrink your fibroids.
- You may have outpatient surgery, which means you would go home the same day. Or you may spend 1 to 4 days in the hospital after surgery.
- Recovery can take from a few days to 6 weeks, depending on the type of surgery you have.
- If you have your uterus taken out, you won't be able to get pregnant.
- Either surgery can ease your pain and other symptoms.
- Surgery to take out just your fibroids (myomectomy) may make it possible for you to get pregnant.
- Surgery to take out your uterus (hysterectomy) will cure your fibroids.
- Both surgeries have risks, some of which are rare. Risks include bleeding, infection, and scar tissue.
- Cutting into the uterus to take out just the fibroids could cause a problem with how the uterus works in a future pregnancy.
- Pelvic pain that you had before either surgery may not get better.
- If you have just the fibroids taken out but not the uterus, the fibroids can grow back.
- You may be able to control your symptoms without surgery.
- If you have bad symptoms and are close to menopause, you may be able to control your symptoms long enough to go through menopause.
- You won't have the risks of surgery.
- Your pain or other symptoms could get worse.
- If fibroids are making it hard for you to get pregnant, NSAIDs and hormones won't help you get pregnant.
- NSAIDs can cause bleeding and other problems in some people. Talk to your doctor before taking them.
- Hormones can have serious side effects, such as menopause symptoms and bone-thinning.
- Fibroid embolization can have side effects such as infection and pain.
Personal stories about surgery to treat uterine fibroids
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
Uterine fibroids made me miserable for a week to 10 days every month. Since my husband and I did not want any more children, I decided it was time to take action. Not only was the pain getting to me, but I was losing enough blood that I had anemia I couldn't beat. I was tired all the time! I knew a hysterectomy was the only sure cure for the pain caused by uterine fibroids. My doctor talked with me about the discomfort and risks of a hysterectomy. She also said she might have to remove my ovaries. I had a hysterectomy, and my ovaries were removed. The first 2 weeks after the surgery were pretty rough, but my family and I managed. I now take estrogen every day. It's been a year since my surgery, and I feel great.
Cheryl, age 45
My periods were really painful about 5 years ago. I went to my doctor, and he asked a lot of questions about my periods and did an exam and some tests. When all the tests came back normal, he said uterine fibroids might be the cause of my pain. He said the only sure treatment for uterine fibroids was a hysterectomy. I didn't want to have surgery, so I asked if waiting a few months would be dangerous. He said waiting would be fine, and maybe I should try birth control pills and taking ibuprofen during my periods. After a few months, the pain eased up. I am glad I decided to wait and see if my pain decreased before having surgery.
Francine, age 42
I have large uterine fibroids and have had them since I was in my early 30s. They didn't cause any problems until I got pregnant with my first child. I went into labor about a month early, and my daughter had to spend several days in the intensive care unit. My husband and I would like to have one more child, but I want to avoid another premature labor if I can. My doctor has told me about a procedure called a myomectomy. It doesn't guarantee that I won't deliver early, but it may help. He will be able to remove the uterine fibroids from my uterus without taking my uterus out. I won't have to have a large incision in my abdomen either. I am looking forward to having this done. We will wait several months and then try to have another child. Even if I need to deliver by cesarean after a myomectomy, I'm happy to have the chance of a full-term pregnancy!
Terry, age 37
I was surprised when my doctor told me that uterine fibroids could be the cause of the pain I was having with my periods. I had never heard of uterine fibroids before. He told me all about uterine fibroids and the treatments I could try. When he said using ibuprofen for a few days right before my period starts and then for several days during my period might stop the pain, I thought I might as well try it. It took a couple of months of using this system, but now I hardly have any pain. I am glad that I did not have surgery.
Ginny, age 37
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery for fibroids
Reasons not to have surgery for fibroids
I'm having trouble getting pregnant because of fibroids, so I want to have them taken out.
Fibroids aren't keeping me from getting pregnant.
I have so much bleeding and pain that I'm miserable part of every month.
I can control my symptoms with medicine.
I want to do everything I can to treat my fibroids.
I don't want to have any surgery.
I'm not close to menopause, and I can't stand my symptoms, so I want surgery.
I'm close to menopause, so I'd rather try hormones and pain medicine until menopause.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
NOT having surgery
What else do you need to make your decision?
Check the facts
Surgery to take out just my fibroids will cure my problem.
- TrueSorry, that's not right. Fibroids can grow back after surgery to take them out. The only cure for fibroids is surgery to take out your uterus (hysterectomy).
- FalseYou're right. Fibroids can grow back after surgery to take them out. The only cure for fibroids is surgery to take out your uterus (hysterectomy).
- I'm not sureIt may help to go back and read "Get the Facts." Fibroids can grow back after surgery to take them out. The only cure for fibroids is surgery to take out your uterus.
Surgery to take out just my fibroids is the best choice if fibroids are keeping me from getting pregnant.
- TrueThat's right. Surgery to take out fibroids is the best choice if you want to get pregnant. Surgery to take out your uterus would mean that you can't get pregnant.
- FalseSorry, that's not right. Surgery to take out fibroids is the best choice if you want to get pregnant. Surgery to take out your uterus would mean that you can't get pregnant.
- I'm not sureIt may help to go back and read "Get the Facts." Surgery to take out fibroids is the best choice if you want to get pregnant.
If I'm close to menopause, taking nonsteroidal anti-inflammatory drugs (NSAIDs) and maybe hormones may be all that I need to help my symptoms.
- TrueYou're right. Fibroids usually get smaller or go away after menopause. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) and maybe hormones may help your symptoms until you go through menopause.
- FalseNo, that's not correct. Fibroids usually get smaller or go away after menopause. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) and maybe hormones may help your symptoms until you go through menopause.
- I'm not sureIt may help to go back and read "Get the Facts." Fibroids usually get smaller or go away after menopause. Taking anti-inflammatory medicine and maybe hormones may help your symptoms until you go through menopause.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Divya Gupta, MD - Obstetrics and Gynecology, Gynecologic Oncology|
- Practice Committee of the American Society for Reproductive Medicine, Society of Reproductive Surgeons (2008). Myomas and reproductive function. Fertility and Sterility, 90(3): S125–S130.
- Parker WH (2012). Uterine fibroids. In JS Berek, ed., Berek and Novak's Gynecology, 15th ed., pp. 438–469. Philadelphia: Lippincott Williams and Wilkins.
- Parker WH, et al. (2009). Ovarian conservation at the time of hysterectomy and long-term health outcomes in the Nurses' Health Study. Obstetrics and Gynecology, 113(5): 1027–1037.
Last Updated:April 19, 2013