Surgery Overview

Myomectomy is the surgical removal of
fibroids from the uterus. It allows the uterus to be
left in place and, for some women, makes pregnancy more likely than before.
Myomectomy is the preferred fibroid treatment for
women who want to become pregnant. After myomectomy, your chances of pregnancy
may be improved but are not guaranteed.

Before myomectomy,
shrinking fibroids with
gonadotropin-releasing hormone analogue (GnRH-a) therapy may reduce blood loss from the surgery. GnRH-a therapy lowers
the amount of estrogen your body makes. If you have bleeding from a fibroid,
GnRH-a therapy can also improve
anemia before surgery by stopping uterine bleeding for
several months.

Surgical methods for myomectomy include:

  • Hysteroscopy,
    which involves inserting a lighted viewing instrument through the vagina and
    into the uterus.
  • Laparoscopy, which uses a lighted
    viewing instrument and one or more small cuts (incisions) in the
    abdomen.
  • Laparotomy, which uses a larger
    incision in the abdomen.

The method used depends on the:

  • Size, location, and number of fibroids.
    • Hysteroscopy can be used to remove fibroids
      on the inner wall of the uterus that have not grown deep into the uterine wall.
    • Laparoscopy is usually reserved for removing one or two fibroids,
      up to about 2 in. (5.1 cm)
      across, that are growing on the outside of the uterus.
    • Laparotomy
      is used to remove large fibroids, many fibroids, or fibroids that have grown
      deep into the uterine wall.
  • Need to correct urinary or bowel problems. To
    repair these problems without causing organ damage, laparotomy is usually
    needed.

What To Expect After Surgery

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

  • 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. Before an
    in vitro fertilization, myomectomy is often done to
    improve the chances of pregnancy.

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 having a baby. 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.footnote 1

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 return after surgery in 10 to 50 out of 100 women, depending on the original fibroid problem. Fibroids that were
larger and more numerous are most likely to recur.footnote 2
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.
  • Removal of fibroids in the
    uterine muscle (intramural fibroids) may cause scar
    tissue.
  • In rare cases, scarring from the uterine incision may cause
    infertility.
  • In rare cases, injuries to the bladder or bowel, such
    as a
    bowel obstruction, may occur.
  • In rare
    cases, uterine scars may break open (rupture) in late pregnancy or during
    delivery.
  • In rare cases, a hysterectomy may be required during a myomectomy. This may happen if removing the fibroid causes heavy bleeding that cannot be stopped without doing a hysterectomy.

What To Think About

When trying to get pregnant after myomectomy. Because fibroids can grow back, it is best to try to conceive as
soon after a myomectomy as is safely possible and your recovery from surgery is complete.

When incisions have been made into the uterine wall to
remove fibroids, future pregnancy may be affected. Sometimes
placenta problems develop, such as
placenta abruptio or
placenta accreta. During labor, the uterus may not
function normally, which can make a
cesarean delivery necessary.

In rare
cases, a hysterectomy is needed when the surgery reveals that the
uterus is too overgrown with fibroids for a safe myomectomy.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

Citations

  1. Parker WH (2012). Uterine fibroids. In JS Berek, ed., Berek and Novak’s Gynecology, 15th ed., pp. 438-469. Philadelphia: Lippincott Williams and Wilkins.
  2. Practice Committee of the American Society for Reproductive Medicine, Society of Reproductive Surgeons (2008). Myomas and reproductive function. Fertility and Sterility, 90(3): S125-S130.

Credits

ByHealthwise Staff
Primary Medical Reviewer Sarah Marshall, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Martin J. Gabica, MD – Family Medicine
Specialist Medical Reviewer Divya Gupta, MD – Obstetrics and Gynecology, Gynecologic Oncology

Current as ofOctober 6, 2017