The indications for radical operation in fibroids of the uterus have been widely extended during the past eight years, principally as the result of the careful statistical work of Webster,1 Noble,2 Eastman3 and others. While numerous gynecologists agree with these writers in holding that practically all fibroids should be removed as soon as discovered, many still follow the older, the classical teaching, that there must be one of more of five indications present before operation is decided on, the alternative being careful and frequent observation. These indications, as stated with minor variations by Pfannenstiel,4 Clark,5 Kelly6 and Webster,1 are (1) hemorrhage, (2) pain, (3) rapid growth, (4) complications in organs other than the uterus, and (5) mental anxiety.
Of these indications, hemorrhage is the most frequent. However, there are few exact statistics as to the frequency of this symptom, for the reason that
SCHENCK BR. FIBROMYOMATA OF THE UTERUS AND ANEMIA.. JAMA. 1908;LI(17):1395–1398. doi:10.1001/jama.1908.25410170011001b