Objective: To analyze trends in surgical management of uterine fibroids and identify factors influencing surgical decisions among Chinese women over the past decade. Design: Retrospective cohort study. Setting: Four campuses of Tongji Hospital, Wuhan, China. Population or Sample: Women diagnosed with uterine fibroids undergoing surgical treatment between 2013 and 2022. Methods: Data from surgical inpatients were analyzed for annual rates of hysterectomies and myomectomies. Univariate and multivariate logistic regression models were used to identify factors associated with choice of surgery. Main Outcome Measures: Rates of hysterectomy and myomectomy over time, factors influencing surgical decision-making, including patient demographics, clinical characteristics, and pre-operative parameters. Results: During the study period, 13,344 women underwent surgery for uterine fibroids, with 4868 opting for hysterectomies and 8476 for myomectomies. Hysterectomy rates decreased from 42.3% to 33.1%, with the 45-49 age group contributing most to this decline, followed by the 40-44 age group. Myomectomy rates increased from 57.7% to 66.9%. Higher likelihoods of hysterectomy were associated with symptomatic fibroids, lower pre-operative hemoglobin, multiple fibroids, older age at admission or menarche, and higher BMI. Among hysterectomy patients, 34.7% also had oophorectomy, compared to 1.1% in the myomectomy group. Conclusions: Surgical management of uterine fibroids in central China has shifted towards increased utilization of myomectomy over hysterectomy, particularly among women aged 40-49. This transition is critical given potential adverse outcomes associated with hysterectomy in premenopausal women.