Myomectomy

Myomectomy may be an option for uterine fibroid removal in women who want to keep their uterus. Your doctor may recommend myomectomy if uterine fibroids are causing problems. This includes:

• Anemia

• Heavy menstrual bleeding or spotting between periods

• Pain during sex

• Painful menstrual cramps

• Pelvic pain and pressure

• Problems urinating or having a bowel movement

Fibroids can also interfere with fertility. Since myomectomy does not remove the uterus, it is the best option for women who want to have children in the future.

A gynecologist or Ob/Gyn (obstetrician-gynecologist) performs myomectomies. These doctors specialize in the medical and surgical care of the female reproductive system. In general, the more experience a doctor has with the procedure, the better the outcome is likely to be. Find out about your doctor’s experience with myomectomy. Ask about the different types of myomectomy procedures and the outcomes your doctor has seen with each.

Myomectomies take place in a hospital. The surgery requires general anesthesia to put you in a deep sleep. There are three surgical approaches to myomectomy:

• Open surgery involves a large, four-inch incision across your lower abdomen. This “bikini cut” allows the doctor to directly view and access the surgical site.

• Laparoscopic surgery involves inserting a laparoscope and special instruments through several small incisions in your abdomen. A laparoscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your abdomen to a video screen. Your doctor performs the surgery using the video images to view the surgical area.

• Hysteroscopic surgery involves inserting a hysteroscope through the cervix into the uterine cavity. Your feet will be in gynecology stirrups similar to a pelvic exam. The doctor will insert a speculum to open your vaginal canal. After the hysteroscope is in place, the doctor will fill the uterus with fluid to inflate the uterine cavity and lift apart the uterine walls. The doctor will use specialized instruments through the hysteroscope to remove fibroids from the inner wall of the uterus. There are no skin incisions with this procedure.

For laparoscopic and open surgery, the doctor cuts out the fibroids. Then, the doctor will sew the uterine muscle back together and close the incisions.

Laparoscopic surgery tends to have a faster recovery and cause less pain and other problems. Open surgery usually involves a longer recovery and more pain afterwards. Despite this, open surgery may be a safer and more effective choice for some uterine fibroids and for some patients. Your doctor may also perform an open procedure after starting a laparoscopic one. When fibroids are within the muscle wall, open surgery is usually preferable for women who want to become pregnant in the future.

Ask your doctor about the different myomectomy procedures. Find out why your doctor recommends a particular type for you.

In general, this is what happens the day of your surgery: 

• You will talk with a preoperative nurse who take your vital signs and ask you questions about your presurgical preparations. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

• You will change into a hospital gown. The nurse will place your clothing and other belongings into a bag.

• You will talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have. Your surgeon will also come by to speak with you before the procedure starts. This is the time to ask any lingering questions about the procedure or recovery.

• You will get an IV (intravenous) line and a sedative to help you relax before the team takes you to the OR (operating room).

• Your team will start general anesthesia in the OR. You won’t remember anything else until you wake up in the recovery room.

Your team will monitor your vital signs and other critical body functions during surgery. This will continue throughout your recovery until you are breathing effectively and your vital signs are stable.

All surgeries carry risks and have the potential for complications. Some of these can be serious and may occur during surgery or develop while you are recovering.

The general risks of surgery include:

• Anesthesia reaction, such as an allergic reaction and problems with breathing

• Bleeding

• Blood clots

• Infection

Most myomectomies are successful, but potential complications include:  

• Development of adhesions, which are bands of scar tissue that can entrap nearby organs and structures

• Injury to internal organs

• Need for a hysterectomy due to excessive bleeding or problems during surgery (rare)

• Weakening of the uterine wall, requiring a C-section for future deliveries

You can reduce your risk of certain complications by:

• Following your doctor’s pre- and postoperative instructions including medications

• Informing your doctor if there is any possibility of pregnancy

• Contacting your doctor immediately for such concerns as bleeding, fever, or pain not controlled by pain relievers or narcotics (if prescribed)

• Telling all members of your care team if you have allergies

In addition, your doctor may recommend other strategies to minimize your risk of complications. This can include taking iron supplements to maximize your blood counts before surgery. You may also need to take hormonal medications to decrease menstrual flow and shrink the fibroids.

You can prepare for myomectomy and increase your chances of a successful outcome by:

• Getting preoperative testing if your doctor orders it

• Losing excess weight before surgery

• Making sure all your healthcare providers have your complete medical history. This includes chronic conditions, allergies and medications. When listing medications, include prescriptions, over-the-counter drugs, herbal treatments, and vitamin supplements.

• Not eating or drinking before surgery as directed

• Stopping smoking as soon as possible to help the healing process

• Taking or stopping medications as directed

Making a list of questions can help you remember everything you want to ask your doctor. Your questions may include:

• Are there any other options for treating my fibroids?

• What type of myomectomy procedure will I need?

• How long will the surgery take? When can I go home?

• What restrictions will I have after the surgery?

• What types of everyday activities might be more difficult or painful for me while I’m recovering?

• What kind of assistance will I need at home?

• When can I return to work and other activities?

• What medications will I need before and after the surgery? How should I take my usual medications?

• How will you treat my pain?

• When should I follow up with you?

• How should I contact you? Ask for numbers to call during and after regular hours.

When you know what to expect, it’s often easier to plan and prepare for a successful recovery.

Hysteroscopic myomectomy is an outpatient procedure. You will spend a few hours in the recovery room and go home the same day. For laparoscopic myomectomy, most women stay overnight in the hospital. You will likely spend two nights in the hospital if you have an abdominal (open) myomectomy.

Myomectomy recovery is a gradual process. Your age and overall health before surgery can influence your recovery time. Hysteroscopic myomectomy usually involves a short recovery of a few days. You may have light bleeding and cramping during this time. Recovery from laparoscopic myomectomy typically takes 2 to 4 weeks. Abdominal myomectomy has the longest recovery at 4 to 6 weeks or longer.

You will have pain and discomfort after laparoscopic and abdominal myomectomy. Controlling pain is important for healing and a smooth recovery. It lets you walk and move around comfortably, which will speed your recovery. Tell your doctor if your pain changes in any way. It could be a sign of a complication.

Contact your doctor’s office if you have questions between follow-up appointments. Call your doctor right away or seek immediate medical care if you have:

• Breathing problems or shortness of breath

• Confusion or changes in level of alertness

• Chest pain, pressure or tightness

• Drainage of pus, redness or swelling around your incision

• It’s common to have a fever right after surgery. Your doctor will give you instructions about when to call for a fever.

• In ability to urinate or move your bowels

• Leg pain, redness or swelling, which could mean you have a blood clot

• Severe nausea and vomiting

• Unexpected bleeding

Most women have symptom relief following myomectomy. Excessive menstrual flow and pelvic pain subside after the procedure. Fertility often improves as well. In general, doctors recommend waiting at least three months to try to become pregnant. This allows the uterus time to fully heal.

Some women will experience a recurrence of fibroids after myomectomy. Younger women and those with multiple fibroids are more likely to have problems with fibroids in the future. Older women with a single fibroid are least likely to have a recurrence.