Will surgery affect my fertility?

Myomectomy is designed to preserve fertility. In fact, removing submucosal or large fibroids can improve your chances of conceiving. Hysterectomy, however, ends fertility permanently.

Can fibroids grow back after myomectomy?

Yes. Myomectomy removes existing fibroids but doesn’t prevent new ones from developing, especially if you’re still menstruating.

Is hysterectomy the only cure for fibroids?

It’s the only permanent cure. All other treatments reduce symptoms but don’t eliminate fibroid recurrence risk.

How do I prepare for fibroid surgery?

Discuss pre-op tests, iron supplements (if anaemic), fertility plans, and post-op recovery timelines with your doctor. Prepare home support for 2–6 weeks, depending on the procedure.

When to Consider Surgery for Uterine Fibroids

A heavy period that floods through your pad in less than an hour. Cramping that doesn’t ease with painkillers. A bloated belly that makes you feel pregnant when you're not. For many women, these symptoms aren’t just monthly nuisances. They’re signs of something deeper: uterine fibroids. While often benign, these growths can interfere with your health, fertility, and quality of life. The real dilemma? Knowing when to wait, when to medicate, and when surgery is the best way forward.

What Are Uterine Fibroids?

Fibroids are non-cancerous growths that develop in or around the uterus. Also called leiomyomas or myomas, they can vary in size from tiny seedlings to bulky masses that distort the uterine shape.

These growths are made of muscle and fibrous tissue, and they often appear during the reproductive years when oestrogen levels are high. Some people have one; others may develop multiple.
Fibroids can grow:

Inside the uterus (submucosal)
In the muscle wall (intramural)
Outside the uterus (subserosal)
Or even attached by a stalk (pedunculated)

You may have them without knowing. But for many, they make their presence painfully obvious.

Why Fibroids Matter: What They Can Affect

The impact of fibroids can be physical, emotional, sexual, and reproductive.

Heavy or prolonged menstrual bleeding: which may lead to anaemia or fatigue.
Severe pelvic pain or pressure: especially if fibroids press against nerves or organs.
Infertility or miscarriage risk: depending on size and location, fibroids may prevent implantation or interfere with pregnancy.
Bladder or bowel dysfunction: subserosal fibroids may press on the bladder, leading to frequent urination or constipation.
Pregnancy complications: including preterm labour, breech position, and delivery difficulties.

When these effects begin disrupting your life or your ability to conceive, conservative options may not be enough.

What Increases Your Risk of Needing Surgery?

Not all fibroids need treatment, and many shrink after menopause. But some signs increase the likelihood that surgery will be recommended:

Persistent heavy bleeding: especially if you’re becoming anaemic or exhausted
Rapidly growing fibroid: raising concerns about rare sarcoma (though most fibroids are benign)
Fibroids interfering with fertility: especially submucosal ones
Severe pain or bloating: affecting sleep or movement
Pressure on bladder or rectum: causing incontinence or constipation
Failed medical management: such as lack of response to hormonal therapy

Your gynaecologist may recommend imaging (usually pelvic ultrasound or MRI) to monitor growth and assess fibroid size, number, and type.

Diagnosing Fibroids: How It’s Confirmed

Diagnosis usually begins with a pelvic exam if your doctor suspects an enlarged uterus.
Tests may include:

Transvaginal or abdominal ultrasound: first-line imaging to assess size and location.
MRI: used when more detailed mapping is needed, especially before surgery.
Hysteroscopy or saline sonohysterography: to visualise submucosal fibroids.
Blood tests: to rule out anaemia from heavy bleeding or elevated CA-125 (though not specific).

Fibroids are typically diagnosed by imaging, not biopsy since they’re rarely malignant.

Treatment Options: Medical First, Surgical If Needed

Surgery is not always the first step. Medical options often come first, especially if symptoms are mild or fertility preservation is a priority.

Non-Surgical Options

Hormonal treatments: like GnRH agonists or progestin IUDs to reduce bleeding
Tranexamic acid: to control heavy menstrual flow
Pain relief: NSAIDs to manage cramps
Lifestyle adjustments: diet, yoga, acupuncture (supportive, not curative)

But if fibroids are large, symptomatic, or impacting fertility, surgery may be the next step.

Surgical Options

1. Myomectomy
This is the removal of fibroids while preserving the uterus. It’s ideal if:

You plan to get pregnant in the future
Fibroids are distorting the uterine cavity
You’re under 40 and symptomatic

Types of myomectomy:

Hysteroscopic (via cervix, for submucosal)
Laparoscopic (keyhole)
Open (for large/multiple fibroids)

2. Hysterectomy
This is complete removal of the uterus and may be advised if:

You’re done with childbearing
Fibroids are too large or numerous
Symptoms are severe and haven’t improved
Other conditions like adenomyosis are present

A hysterectomy is the only definitive cure for fibroids. However, it’s a major decision with physical and emotional implications, especially for younger women.

Emotional and Practical Considerations Before Surgery

Surgery isn't just a physical decision. It’s an emotional one too.

Fertility goals: If you’re still trying to conceive, preserving the uterus matters. Myomectomy may be the preferred option.
Recovery time: Hysterectomy and open myomectomy involve longer recovery periods. Laparoscopic methods are quicker but may not be suitable for all cases.
Mental impact: Losing the uterus may affect how some women view their identity, even if they don't plan on having children.
Financial and caregiving plans: Time off work, help at home, and hospital costs should be factored in.
Post-op support: You may need pelvic physiotherapy, anaemia management, or counselling after surgery.

Let yourself grieve if you need to. Let yourself rest if you’re healing. And know that choosing surgery isn’t giving up. It’s choosing relief.
Fibroids are common, but their impact isn’t always benign. If your life, your blood levels, or your fertility are being compromised, surgery may not be an overreaction. It may be the path to reclaiming your health. Myomectomy offers hope for those seeking to conceive. Hysterectomy offers closure when other treatments fail. Either way, you deserve answers, not just options.

FAQs on Uterine Fibroids: When Is Surgery the Right Option?

Will surgery affect my fertility?
Myomectomy is designed to preserve fertility. In fact, removing submucosal or large fibroids can improve your chances of conceiving. Hysterectomy, however, ends fertility permanently.
Can fibroids grow back after myomectomy?
Yes. Myomectomy removes existing fibroids but doesn’t prevent new ones from developing, especially if you’re still menstruating.
Is hysterectomy the only cure for fibroids?
It’s the only permanent cure. All other treatments reduce symptoms but don’t eliminate fibroid recurrence risk.
How do I prepare for fibroid surgery?
Discuss pre-op tests, iron supplements (if anaemic), fertility plans, and post-op recovery timelines with your doctor. Prepare home support for 2–6 weeks, depending on the procedure.