Not necessarily. Surgery is only one option, and whether it’s recommended depends on whether fibroids are causing significant symptoms and what your fertility and uterus-preservation goals are.
Fibroids and Fertility: Choosing the Right Treatment
Fibroid treatment isn't determined by how many fibroids show up on an MRI, it's determined by your goals. Dr. Toubia walks through the options (myomectomy, focused ultrasound/radiofrequency ablation, and UAE) and explains why fertility and uterus-preservation priorities should drive the decision, not the imaging report.
If you’ve been diagnosed with uterine fibroids, the first question isn’t which treatment to choose, it’s whether treatment is even necessary. According to Dr. Tarek Toubia, gynecologic surgeon at PRM Nashville, fibroid treatment decisions come down to two questions, and neither of them is “how many fibroids do I have?”
Not every fibroid needs to be treated. If fibroids are present but not causing symptoms, monitoring is a completely reasonable approach — there’s no inherent urgency to intervene just because something showed up on imaging.
Treatment becomes necessary when fibroids are actually driving real problems: heavy bleeding, pain, or fertility difficulties. That distinction matters, because it shifts the conversation away from “what does the scan show” and toward “what is actually happening to you.”
Once treatment is warranted, the second, and arguably more important, question is what a patient wants for her future fertility and her uterus. This is where fibroid treatment stops being a single standardized path and starts requiring a genuinely individualized plan.
For patients who want to preserve fertility or simply prefer to keep the uterus intact, the conversation shifts toward uterus-sparing and fertility-sparing options.
Myomectomy. This is the standard fertility-preserving surgery, the fibroids are surgically removed while the uterus itself stays intact. It’s a major surgery, even when performed via minimally invasive techniques, and patients who become pregnant afterward will typically need a C-section for delivery.
Focused ultrasound and radiofrequency ablation. These techniques use targeted technology to shrink fibroids and reduce symptoms while preserving the uterus and fertility. The tradeoff: pregnancy outcome data for these approaches is still developing, so patients considering future pregnancy should understand that the long-term picture isn’t as established as it is for myomectomy.
Uterine artery embolization (UAE). This can effectively treat fibroids and may be a good option for patients who aren’t strong surgical candidates or who prefer to avoid surgery altogether. However, it’s generally not considered first-line for patients actively planning to become pregnant, due to a potentially higher complication rate during pregnancy.
According to Dr. Toubia, the right fibroid treatment isn’t dictated by the ultrasound report or the MRI findings, or even by how many fibroids are present. It’s dictated by a patient’s actual goals and priorities — how important preserving fertility is, how important preserving the uterus is, and how a patient weighs the tradeoffs of each option against those priorities.
That’s also why a real treatment conversation should never start with a recommendation before it starts with a question: what do you want for your future?
Not necessarily. Surgery is only one option, and whether it’s recommended depends on whether fibroids are causing significant symptoms and what your fertility and uterus-preservation goals are.
Myomectomy is a surgery that removes fibroids while keeping the uterus intact, and is the standard fertility-preserving option. UAE (uterine artery embolization) is a non-surgical procedure that can treat fibroids but carries a higher complication rate during pregnancy, so it’s generally not first-line for patients actively planning to conceive.
They can preserve the uterus and fertility, but pregnancy outcome data for these techniques is still developing, so that uncertainty is worth discussing with your provider if future pregnancy is a priority.
Most patients who become pregnant after a myomectomy will need a C-section for delivery.
It depends on whether your fibroids need treatment at all, and if so, how important preserving fertility or your uterus is to you — that conversation, not the imaging report alone, should guide the decision.
