Myomectomy
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
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.
References
Citations
- Parker WH (2012). Uterine fibroids. In JS Berek, ed., Berek and Novak's Gynecology, 15th ed., pp. 438-469. Philadelphia: Lippincott Williams and Wilkins.
- 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.
Current as of: October 6, 2017
