Dra. Samanta Soares

Obstetrician Gynaecologist

Surgical treatment of uterine fibroids

HPA Magazine 24 // 2025

Uterine fibroids are a very common condition that affects 70 to 80% of women throughout their reproductive years.
They may be asymptomatic, in which case they only require monitoring, or they may cause significant complaints that have a major impact on the patient's quality of life.
The decision on the best treatment for uterine fibroids for each patient should be the result of a discussion between the patient and her doctor and should address several factors. It is important to take into account the type of symptoms, the patient's age, the desire to preserve fertility, the effectiveness, risks, and duration of treatment, the availability and costs of treatment, and the likelihood of recurrence of symptoms.
Generally, surgical intervention is indicated for symptomatic women in whom pharmacological therapy has either failed or is contraindicated.
We can use hysterectomy, myomectomy, or endometrial ablation.

Hysterectomy involves removing the uterus, making future pregnancy impossible but providing a definitive solution and virtually complete remission of symptoms. It can be performed using the classic or open approach, in which an incision is made in the abdominal wall similar to that of a cesarean section, or by laparoscopy, in which the operation is performed through four small holes. Laparoscopic hysterectomy allows for a faster recovery, has a lower risk of infection and bleeding from the surgical wound, has a lower risk of pelvic adhesions and hernia of the surgical scar, and is generally the first surgical approach option. However, it has limitations that may make it impossible to recommend if the uterus is large and/or adherent to the surrounding organs.

Myomectomy, a treatment in which only the fibroids are removed, preserving the uterus, allows fertility to be maintained but only improves bleeding in 70 to 80%, and it is estimated that complaints recur in 40 to 50% of patients. It can be performed either openly or laparoscopically, with advantages and limitations comparable to those of hysterectomy. In the case of fibroids located inside the uterine cavity, hysteroscopic surgery is recommended, in which the fibroid is accessed through the vagina and cervix and operated from the inside out. This technique has the easiest recovery and the fewest surgical risks, but in large fibroids, it may involve more than one procedure.

Endometrial ablation consists of destroying the endometrium, the inner layer of the uterus that undergoes changes during the menstrual cycle and whose shedding causes menstruation. It is only applied to patients in whom excessive bleeding is the only symptom of uterine fibroids. It is performed vaginally and also has a very satisfactory recovery, but its effectiveness varies depending on the technique used, as does the likelihood of recurrence of symptoms.

In conclusion, the surgical treatment of uterine fibroids must be carefully considered, taking into account the particularities of each patient and the nature of the fibroids. Surgical options such as hysterectomy, myomectomy, and endometrial ablation offer effective solutions to alleviate symptoms and improve quality of life, and it is crucial that patients are fully informed about the risks and benefits of each approach. As new techniques emerge and knowledge about the management of fibroids evolves, treatment is expected to become even more personalized and effective, thus ensuring quality care for all women affected by this condition.