Myomectomy

Surgery Overview

Myomectomy is surgery that removes uterine fibroids. The uterus is left in place. This option may be recommended if you want to get pregnant in the future or want to keep your uterus. In some cases, it may improve chances of pregnancy.

Before myomectomy, gonadotropin-releasing hormone analogue (GnRH-a) therapy may be used to shrink fibroids and the uterus. This may allow your doctor to use a smaller cut during the surgery. And it can also improve anemia before surgery by stopping uterine bleeding for several months.

There are different ways to do the surgery. In a hysteroscopic myomectomy, a lighted tube is inserted through the vagina and into the uterus. In a laparoscopic myomectomy, a lighted tube and surgical tools are put through small cuts in your belly. In an abdominal myomectomy, the fibroids are removed through a larger cut in the belly.

The method used depends on the size, location, and number of fibroids.

What To Expect

The length of time you may spend in the hospital varies.

• Hysteroscopy is an outpatient procedure.
• Laparoscopy may be an outpatient procedure or may require a stay of 1 day.
• Laparotomy requires an average stay of 1 to 4 days.

Recovery time depends on the method used for the myomectomy:

• Hysteroscopy requires from a few days to 2 weeks to recover.
• Laparoscopy requires 1 to 2 weeks.
• Laparotomy requires 4 to 6 weeks.

Why It Is Done

Myomectomy keeps the uterus while treating fibroids. It may be a reasonable treatment option if you have:

• Heavy uterine bleeding or anemia that is not relieved by treatment with medicine.
• Pain or pressure that is not relieved by treatment with medicine.
• A fibroid that has changed the wall of the uterus. This can sometimes cause infertility. Myomectomy may improve your chances of getting pregnant.

How Well It Works

Myomectomy decreases pelvic pain and bleeding from fibroids.

Pregnancy

Myomectomy is the only fibroid treatment that may improve your chances of getting pregnant. It is known to help with a certain kind of fibroid called a submucosal fibroid. But it does not seem to improve pregnancy chances with any other kind of fibroid.

After myomectomy, a cesarean section may be needed for delivery. This depends in part on where and how big the myomectomy incision is.

Recurrence

Fibroids can return after surgery, depending on the original fibroid problem. Fibroids that were larger and more numerous are most likely to recur. Talk to your doctor about whether your type of fibroid is likely to grow back.

Risks

Risks may include the following:

• Infection of the uterus, fallopian tubes, or ovaries (pelvic infection) may occur.
• Injury to the pelvic organs, such as the uterus, bladder, or bowel.
• Scar tissue may form. In rare cases, this may cause fertility problems.
• Bleeding (hemorrhage).
• Unplanned hysterectomy. This may happen if removing the fibroid causes heavy bleeding that cannot be stopped without doing a hysterectomy.