What is the treatment of choice for a woman with symptomatic uterine fibroids?

The treatment of choice for a woman with symptomatic uterine fibroids is typically myomectomy or hysterectomy. This approach is particularly indicated for women experiencing significant symptoms such as heavy menstrual bleeding, pelvic pain, or pressure symptoms that interfere with daily activities.

Myomectomy is a surgical procedure that involves the removal of fibroids while preserving the uterus, which is often preferred for women who wish to retain their fertility. Hysterectomy, the removal of the uterus, may be recommended for women who are not planning future pregnancies and have more severe symptoms or if the fibroids are particularly large or numerous.

Other treatments such as hormonal therapy can help manage symptoms but may not provide a definitive solution or removal of the fibroids themselves. Watchful waiting is appropriate for asymptomatic fibroids or in cases where the symptoms are mild. Endometrial ablation might be considered in certain cases but is not suitable for all patients, particularly those who wish to maintain their ability to conceive. Therefore, myomectomy or hysterectomy represents the most effective solution for significant symptomatic management of uterine fibroids.