Introduction
When I first learned about fibroids, I was surprised to know they are the commonest benign uterine tumors, affecting around 20–40% of women during their reproductive years1, 2. In my practice, I have often seen how they bring clinical symptoms like heavy menstrual periods, pressure on surrounding organs, and even fertility problems. Many women I met were anxious because in the UK and USA, fibroids are a primary indication for hysterectomy, yet not everyone feels ready for such surgery. Some women discover uterine fibroids only during a routine gynecological examination or while doing pelvic imaging for completely unrelated issues. What makes them tricky is that whether they show up as symptomatic or not depends on their size and position within the uterine cavity.
While surgical removal is often called the definitive management for symptoms attributable to fibroids, I’ve also noticed many patients decline it and instead choose medical options. The natural history of fibroids is still poorly understood, making it hard to advise asymptomatic women about the future. From what research shows, fibroids are highly sensitive to circulating estrogens, which may make them grow or simply maintain their size. Still, it remains unclear how much their growth is influenced by factors beyond ovarian steroid hormones. The aim of a retrospective study I came across was to describe the natural history of fibroids in premenopausal women and explores how demographic and morphological features might influence their growth rate.
What is a hysterectomy for fibroids?
From my years of working with women’s health, I’ve seen how a hysterectomy can feel like both a relief and a tough decision. In simple terms, it is a procedure that surgically removes either a part of the uterus or the whole organ. Depending on the case, the surgeon may also take out the fallopian tubes, ovaries, or even the cervix. I remember one patient who was anxious about whether her ovaries would be removed, but in most women undergoing a hysterectomy, the ovaries are kept, no matter the age. This often eases the fear of early menopause and helps maintain natural hormone balance.
Still, the situation can change if doctors spot ovarian masses or other concerning issues during surgery or right in the middle of the operation. Over time, I’ve noticed that hysterectomies are usually performed when all other treatments don’t bring relief from fibroids or persistent chronic conditions in the uterus or pelvis. For many, it is the turning point toward regaining comfort and control over their health
Hysterectomy types
When I first explained the two main types of hysterectomies to a patient, she was surprised by how different they could be. A supracervical or “partial” hysterectomy removes the uterus but leaves the cervix in place, while a total hysterectomy goes further and takes out both the uterus and cervix completely. Each approach carries its own impact, and I’ve seen women feel more confident once they understand these differences clearly.
There are also different techniques for performing the surgery, and the choice often depends on your medical history, personal preferences, and the surgeon’s expertise. At centers like UCLA, these options include methods tailored to fit a patient’s needs. In my experience, discussing all possibilities openly helps women feel more in control of the process and reduces anxiety before surgery.
Laparoscopic hysterectomy
In many cases, a laparoscopic hysterectomy is suggested because it allows the surgeon to use small incisions and a camera to guide the surgery, making recovery faster and less painful compared to open methods. From my experience, women appreciate that this technique often reduces anxiety, as the process feels less invasive and offers more control over outcomes. The choice still depends on your medical history, personal preferences, and the surgeon’s expertise, but centers like UCLA often include this method among the available options. I’ve seen patients feel more confident and relieved when such possibilities are explained openly, as it helps them understand how the approach can be tailored to their needs while minimizing impact and supporting quicker healing.
Treatment
From what I’ve observed, women who are without symptoms usually do not need immediate treatment, though staying evaluated regularly by doctors is wise. For women with fibroids, there are many options such as drugs or surgery, and I’ve seen how several choices can impact the chances of becoming pregnant. In some cases, fibroids usually shrink after menopause, so those close to the average age of 51 or 52 may choose to defer treatment. Still, this is a slow process, and it should not be assumed that very large fibroids will disappear quickly.
The Female Reproductive System
In my years of explaining anatomy, I’ve often described the primary structures of the reproductive system starting with the uterus, a pear-shaped organ lying between the bladder and intestine, made of the body and cervix. When a woman is not pregnant, the size is like a fist, with walls pressed together, but during pregnancy the fetus grows and stretches them apart. The cervix, the lower portion of the uterus, has a canal and opening into the vagina, where the os allows menstrual blood to flow and later dilates for the birth of a child. On each side, the fallopian tubes lead to an ovary; the ovaries are egg-producing organs containing about 200,000 to 400,000 follicles or tiny sack-like cellular structures from Latin “follicles,” holding the material for ripened eggs or ova. The inner lining, the endometrium, thickens, becomes enriched with blood vessels to support the growing fetus, and if no pregnancy occurs, it is shed as menstrual mucus.
Effect on Pregnancy
From my experience working with expectant mothers, fibroids can increase pregnancy complications and create serious delivery risks. Sometimes a cesarean section becomes necessary because of problems during labor, and it can be more complicated when the uterine wall has growths. I have also seen cases of breech presentation, where the baby enters the birth canal upside down with feet or buttocks emerging first. Other challenges may include preterm birth, miscarriage, or placenta prevails, where the placenta covers the cervix. After delivery, some women face excessive bleeding when giving birth, known as postpartum hemorrhage, which requires immediate care.
Ultrasound
From my own experience in medical practice, ultrasound has always been the standard and most trusted imaging technique for detecting uterine fibroids, as it is safe, quick, and completely painless. A doctor may advise both Trans abdominal and transvaginal methods: in one, the probe is gently moved across the abdominal area, while in the other, it is carefully inserted into the vagina to give a closer image of the uterus and ovaries. What makes this tool reliable is how sound waves create clear results without discomfort. In some cases, a variation known as hysterosonography is suggested, where saline (salt water) is infused into the uterus, allowing better visualization and enhancing the overall detail of the scan.
Symptoms
From my own medical experience, I have seen that women often describe heavy menstrual bleeding that feels prolonged, with clots and severe cramping during their periods. Some also report abdominal pressure and pain, especially in the lower back, which can resemble strong menstrual cramps. When fibroids become larger, they may cause uterine enlargement, creating hard lumps in the abdomen and even giving the appearance of pregnancy with added heaviness.
Others struggle with pain during intercourse, known as dyspareunia, and in rare cases, penetration is prevented. I have also noted urinary problems like frequent urination, the urge to urinate at night, or even urinary retention when fibroids press against the bladder, urethra, or ureters, sometimes blocking the flow of urine from the kidneys. Lastly, constant fibroid pressure against the rectum may lead to persistent constipation, which many women find very distressing.
Postoperative Care
In my own recovery journey, I learned that asking a family member or friend to support you during the first few days at home makes a big difference. For the first 1 to 2 days after surgery, medications help prevent nausea, while painkillers ease pain around the incision site. My doctor encouraged me to walk and do slow, deep breathing exercises soon after the operation, which helped reduce the risk of blood-clot formation, eased gas pains, and sped up recovery. Small habits like holding a pillow on the abdominal wound while coughing or crossing the legs after vaginal surgery helped reduce discomfort.
I avoided lifting heavy objects, climbing stairs, driving, or taking baths for several weeks, just as advised. Talking openly with my surgeon about when it was safe to have sex or start more intense exercise programs made me feel confident in the healing process. Strengthening the abdominal muscles took time, and I experienced some overall weakness even after the wound healed, but eventually, I regained energy. Women who have had abdominal hysterectomies or a cervix removed should also follow up on Pap smears if there’s a history of abnormal results, and continue routine pelvic and breast exams with mammograms to stay on top of their health.
Conclusion on Postoperative Care
Proper postoperative care plays a key role in smooth recovery after surgery. Simple steps like walking early, doing deep breathing exercises, avoiding heavy lifting, and following the doctor’s advice can reduce complications such as pain, infection, or blood clots. Every woman heals at her own pace, so staying patient, seeking family support, and keeping up with medical checkups ensures long-term health and strength.
