Whether or not surgery is needed for uterine fibroids primarily depends on clinical symptoms, with clinical symptoms as the criterion. If the fibroids are small but affect menstruation, such as heavy periods or noticeable prolongation and increase in menstrual flow, surgery might be necessary. Another consideration for surgery is if the fibroid noticeably enlarges in a short period, and there's a suspicion of malignant transformation. Additionally, if there are significant symptomatic compressions clinically, surgery might also be considered. Therefore, if someone has uterine fibroids, it's important to consult with a gynecologist who can assess the situation based on ultrasound and physical examination to determine whether surgery is required.