What is the best way to treat uterine fibroids?

Treatment should be considered comprehensively based on the patient's age, symptoms and fertility requirements, as well as the type, size and number of fibroids.

1. Observation: Asymptomatic fibroids generally do not require treatment, especially in women near menopause. After menopause, fibroids often shrink and symptoms disappear. Follow-up every 3-6 months, and further treatment may be considered if symptoms occur.

2. Drug treatment is suitable for those with mild symptoms, those who are close to menopause or whose general condition is not suitable for surgery.

1 Gonadotropin-releasing hormone analogs: high-dose continuous or long-term non-pulse administration can inhibit FSH and LH secretion, reduce estrogen to postmenopausal levels, relieve symptoms and inhibit the growth of fibroids to shrink them, but they gradually increase again after stopping the drug. The drug can cause menopausal syndrome, and long-term use can cause side effects such as osteoporosis, so long-term use is not recommended. Indications for use: ① Reduce fibroids to facilitate pregnancy; ② Preoperative medication to control symptoms and correct anemia; ③ Preoperative medication to reduce fibroids, reduce the difficulty of surgery, or make vaginal or laparoscopic surgery possible; ④ For near-menopausal women, transition to natural menopause in advance to avoid surgery. Long-acting preparations are generally used once a month.

2 Other drugs: Mifepristone, 10 mg orally per day, can be used as preoperative medication or for early menopause. However, it is not suitable for long-term use because after it antagonizes progesterone, the endometrium is stimulated by estrogen for a long time, increasing the risk of endometrial lesions.

3. Surgical treatment Indications for surgery: ① Excessive menstruation due to fibroids, leading to secondary anemia; ② Severe abdominal pain, dyspareunia or chronic abdominal pain, acute abdominal pain caused by torsion of pedunculated fibroids; ③ Large fibroids compress the bladder, rectum, etc., causing corresponding symptoms; ④ Infertility or recurrent miscarriages due to fibroids; ⑤ Suspected sarcoma.