Is hysterectomy necessary if uterine fibroids become large?

It is not necessary to remove the uterus when uterine fibroids are large. The specific treatment method needs to be comprehensively evaluated based on the size of the fibroids, symptoms and the patient's fertility needs.

For asymptomatic uterine fibroids, even if they are large, regular follow-up is usually recommended. For fibroids that are more than 5 cm in diameter but do not cause obvious discomfort, drug control or minimally invasive surgery may be considered. Gonadotropin-releasing hormone analogs such as leuprolide injections can temporarily shrink fibroids and relieve symptoms. Antiprogesterone drugs such as mifepristone tablets can also inhibit the growth of fibroids. High-intensity focused ultrasound therapy destroys fibroid tissue through precise thermal ablation, preserving the integrity of the uterus. Uterine artery embolization blocks the blood supply to fibroids and shrinks them, and is suitable for patients who want to preserve their fertility.

Hysterectomy may become necessary when fibroids cause severe anemia, compressive symptoms, or suspected malignancy. If the diameter of the fibroid exceeds 10 cm and causes bladder and rectal compression, causing difficulty in urinating or constipation, surgical intervention needs to be considered. When transvaginal ultrasound shows abnormal blood flow signals or rapid growth, uterine resection is required to exclude the possibility of sarcoma. For patients with severe endometriosis or recurrent miscarriage, total hysterectomy can completely solve the problem. However, women under the age of 45 should give priority to myomectomy and use the levonorgestrel sustained-release intrauterine system to prevent recurrence after surgery.

Daily attention should be paid to limiting the intake of phytoestrogens such as soy products, and monthly changes in menstrual flow should be recorded. If lower abdominal distension or prolonged menstruation occurs, ultrasound should be reviewed in time. Patients over 40 years old are recommended to detect tumor markers every year. Those who plan to retain their uterus should avoid long-term use of estrogen-containing health products and choose soothing exercises such as yoga to improve pelvic blood circulation.