NHS GP & Women’s Health Specialist

Dr Sylvia Kama-Kieghe

Surgery is on the table. The appointment is in three weeks. You’ve nodded along through the consultation but you’re walking out with more questions than answers — and you suspect there are things you don’t even know to ask.

That suspicion is correct. Here is the full checklist your surgeon may not volunteer — but absolutely should answer if you ask.

Watch First: Which Myomectomy Is RIGHT for You? — A GP’s Honest Breakdown

Before You Sign Anything — Know Your Surgical Options

There is no single “fibroid surgery.” There are several different procedures, each suited to different fibroid types, sizes, locations, and your reproductive plans.

1. Myomectomy

Myomectomy removes fibroids while preserving the uterus — preferred for women who want to retain fertility. There are three approaches:

• Hysteroscopic myomectomy — for fibroids inside the uterine cavity (submucosal); done through the vagina, no abdominal cuts
• Laparoscopic (keyhole) myomectomy — for fibroids on the outer wall (subserosal) or in the wall (intramural); small abdominal incisions
• Open (abdominal) myomectomy — for very large fibroids, multiple fibroids, or specific locations; larger incision but allows the surgeon best access

2. Hysterectomy

Removal of the uterus. Definitive — fibroids cannot return. Several approaches exist (vaginal, laparoscopic, open). This ends fertility, so it is a major decision that should never be presented as the only option.

3. Uterine Fibroid Embolization (UFE)

A non-surgical procedure performed by an interventional radiologist. Tiny particles are injected into the arteries supplying the fibroids, cutting off blood flow. Fibroids shrink over weeks to months. Preserves the womb, shorter recovery, no general anaesthetic needed in many cases.

4. Other Options

Newer alternatives include MRI-guided focused ultrasound and radiofrequency ablation. Availability varies by NHS trust.

The Questions Your Surgeon Should Answer — But May Not Volunteer

Bring this list. Tick them off in the appointment.

1. Questions About Your Specific Case

1. What type of fibroids do I have? Submucosal, intramural, subserosal, or pedunculated?
2. What is the exact size and location of each one? Ask for the imaging report
3. How many do I have?
4. Do their position or size affect the surgical approach?
5. Is my uterus enlarged? By how much?

2. Questions About the Procedure

1. Which surgical approach are you recommending and why? Is there an alternative?
2. Have I been considered for UFE? If not — why not?
3. What is your personal experience with this procedure? How many do you perform per year?
4. What are the risks specific to my case? General risks are not enough — ask about yours
5. Will my uterus be preserved fully? What scar will be left on the uterine wall?

3. Questions About Recovery and Future Planning

1. What is the recovery time — realistic, not best case?
2. When can I return to work, exercise, sex?
3. If I want to get pregnant, how long must I wait? (Usually 6–12 months after a myomectomy)
4. Will I need a Caesarean if I get pregnant after this? (Often yes — confirm)
5. What is my risk of fibroid recurrence?
6. What are my options if fibroids recur in 5–10 years?

Why Fibroids Grow Back After Surgery – And What to Do About It

What Your Surgeon Probably Won’t Mention — But You Need to Know

This is the section that earns this post its title.

1. Recurrence Rates Are Higher Than You’re Told

After myomectomy, the risk of fibroid recurrence is approximately 15% at 5 years and up to 30% at 10 years. Surgeons sometimes downplay this. Knowing it should not put you off — it should help you make a fully informed decision and plan accordingly.

2. UFE Is Often Underoffered to Women Who Want Future Pregnancies

There has historically been reluctance to offer UFE to women planning pregnancy because of older concerns about fertility and pregnancy outcomes. Newer evidence shows pregnancy is possible after UFE — though myomectomy remains the preferred fertility-preserving option in many cases. You are entitled to a full discussion comparing both.

3. Blood Loss Risk Should Be Discussed Specifically

Fibroid surgery — particularly for large or multiple fibroids — can involve significant blood loss. Ask:

• What is the typical blood loss for my procedure?
• Will I need iron tablets or an infusion before surgery?
• Will I be cross-matched for blood transfusion?
• What is my risk of needing a transfusion?

4. The “Conversion to Hysterectomy” Conversation

In rare cases, a planned myomectomy may need to be converted to a hysterectomy during surgery — for example, if there is uncontrolled bleeding. Ask exactly what circumstances would lead to that decision being made on the table — and what your wishes are. This must be agreed in writing before surgery.

5. Recovery Is Often Longer Than Quoted

Standard quoted recovery times often reflect physical wound healing — not full return to function. Realistic recovery*:

6. Hormonal Pre-Treatment Options

For larger fibroids, your surgeon may use medications like GnRH analogues to shrink fibroids before surgery — improving outcomes and reducing blood loss. Ask if this is appropriate for your case. It is not always offered routinely but can make a meaningful difference.

Red Flags — When to Seek Help

NHS: Fibroids — Treatment Options Including Surgery

Royal College of Obstetricians and Gynaecologists: Uterine Fibroids — Patient Information

American College of Obstetricians and Gynecologists: Uterine Fibroids FAQ

The Bottom Line

Fibroid surgery is a major decision — and major decisions deserve major preparation.

The questions on this list are not aggressive, awkward, or out of place. They are exactly what your surgeon expects from a well-informed patient — and you should walk into your appointment with this checklist in your hand.

Any surgeon who is uncomfortable answering these questions is one you may want a second opinion on. You are the expert on your body. Surgery should always feel like a partnership.

If you’ve had fibroid surgery — what do you wish you’d asked before? The next woman in line is reading. Help her be ready. → Join the free AskAwayHealth community

Similar Topics

• Basic Surgical Options for Fibroids – An Overview
• Treating Fibroids – Which Type of Myomectomy is RIGHT for You?
• More Problems After Fibroid Surgery – Now It’s Adhesions
• Checklist: Ten Things to Expect from Your Fertility Appointment
• Fibroids on the NHS: Your Treatment Options Explained