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The main treatment for symptomatic uterine fibroids is hysterectomy. Hysterectomy is a surgical procedure that involves the removal of the uterus and is typically recommended for women who experience significant symptoms due to fibroids, such as heavy menstrual bleeding, severe pelvic pain, or pressure symptoms affecting quality of life.

While hormonal therapy can help manage symptoms by regulating menstrual cycles and reducing bleeding, it may not adequately address the size of the fibroids or their associated symptoms in the long term. Observation is generally suitable for women who are asymptomatic or whose fibroids are not causing significant issues. Antibiotics would not be indicated in this context, as they do not treat fibroids themselves but are used for infections.

Given the degree of symptoms and the patient's desires, such as whether they wish to maintain fertility, hysterectomy stands out as a definitive solution when other treatments have failed or are unsuitable.