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Objective To evaluate the efficacy of simultaneous or staged management of uterine fibroids by transcervical resection of septum （TCRS）， reproductive endocrinology and clinical prognosis. Methods Clinical data of 87 patients with uterine septum complicated with uterine fibroids were collected. All patients were divided into the simultaneous （<i>n = </i>43） and staged groups （<i>n = </i>44） according to different surgical methods. In the simultaneous group， hysteroscopic TCRS and transcervical resection of myoma （TCRM） were performed simultaneously， whereas staged hysteroscopic TCRS and TCRM were conducted in the staged group. Surgical conditions， postoperative myometrial healing， endometrial and subendometrial blood flow parameters （flow index （FI）， vascularization flow index （VFI） and vascularization index （VI））， endometrial thickness， reproductive endocrine indexes （luteinizing hormone （LH）， follicle stimulating hormone （FSH）， estradiol （E₂））， reproductive outcomes and complications were compared between two groups. Results All patients in both groups completed the surgery successfully. The operation time， time to the first off-bed activity and the length of hospital stay in the simultaneous group were shorter than those in the staged group （all <i>P &lt; </i>0.05）. In the simultaneous group， the proportion of patients with myometrial healing at 1 month after surgery was higher than that in the staged group （<i>P &lt; </i>0.05）. The differences in subendometrial VFI， FI， VI， endometrial thickness and E₂， LH and FSH levels before surgery， 1 month and 3 months after surgery were not statistically significant between two groups （all <i>P &gt; </i>0.05）. The percentage of patients who were pregnant at postoperative 6 months in the simultaneous group was higher than that in the staged group （<i>P &lt; </i>0.05）. The difference in the incidence of complication was not statistically significant between two groups （<i>P &gt; </i>0.05）. Conclusions Simultaneous management of uterine fibroids by TCRS does not affect endometrial hemodynamics， endometrial tolerance， ovarian reserve function and reproductive endocrine function. In addition， it can shorten the operation time， time to the first off-bed activity and length of hospital stay， which is conducive to postoperative pregnancy and has a certain degree of safety.