If the complaints described above occur or if there is no effect after the above regimens, we considersurgical treatment:

1. Indications for surgical treatment

• bleeding, especially leading to anaemia,
• complaints of pain (characteristic in the sacral region) - indicating local compression and stretching of the peritoneum,
• size of the myometrium - when it exceeds the size of the 12 weeks of pregnancy (it then fills the entire small pelvis and makes examination of the adnexa difficult),
• symptoms of compression of the bladder, bowels, ureters (hydronephrosis),
• occurrence of reproductive disorders - failure of pregnancy (after removal of myomas, about 40 % of patients give birth).

2. Surgical procedure: type depends on patient's age, symptoms, plans for future fertility

a) extirpation of my omas (by laparotomy and laparoscopy): in women wishing to become pregnant or in whom pregnancy is not contraindicated; recurrence depends on race, age and extent of surgery - approximately 30% recurrence within 10 years; small submucosal myomas <5-6 cm can be removed by hysteroscopy.

b) Fundectomy

(c) Excision of the uterus (total or supracervical amputation): by laparotomy (with or without adnexa - especially under 40-45 years of age), laparoscopic or vaginal approach.

3. Uterine artery embolisation as a new treatment modality.