What is a myomectomy?
A myomectomy is a procedure to remove fibroids (also known as myomas) from the uterus. Fibroids are growths made up of connective tissue and muscle cells. These growths can present as one or many fibroids growing inside the muscle of the uterus or even elsewhere in the pelvis. They are typically not cancerous. During myomectomy, fibroids are removed, and the uterus is repaired. After this procedure, you will typically have a normally functioning uterus.
In some cases, treatment for fibroids could include a hysterectomy (a procedure to remove the entire uterus). Unlike after myomectomy, women who undergo a hysterectomy can no longer become pregnant.
What are my options if I have fibroids?
Fibroids are extremely common, and most fibroids do not require any treatment.
There are many treatment options for women with fibroids. Your healthcare provider will suggest the procedure that will work the best after considering these factors:
- Your symptoms
- The size, location and number of fibroids
- Your preferences (desire to become pregnant in the future or maintain your uterus for any other reason)
What questions should I ask my healthcare provider before fibroid treatment?
There are several questions you should consider before being treated for fibroids. The answers to these questions will help your healthcare provider determine the best type of treatment.
- Are the fibroids causing any symptoms?
- Do you want the option of future pregnancy?
- Do you want to continue to have periods?
- Do you prefer non-surgical options?
What is the difference between a myomectomy and a hysterectomy?
Myomectomy removes only the fibroids, leaving the uterus in place. This procedure will allow you to have future pregnancies. Periods will return, but hopefully lighter than before the fibroids were removed. There is a chance that new fibroids will develop. The surgery itself often takes longer than a hysterectomy, and there is often more blood loss with a myomectomy.
Hysterectomy is often chosen by women who have completed their child bearing and who do not want to have any periods in the future. Options surrounding the choice for hysterectomy include whether to include removal of the cervix or the ovaries. The route of hysterectomy may be vaginal, abdominal or laparoscopic (minimally invasive technique using small incisions on the abdomen).
What will happen when I choose myomectomy?
When you and your doctor have decided that myomectomy is the right procedure for you, there are still choices to be made. These decisions are based on several factors, including:
- Fibroid size
- The number of fibroids
- Where in the uterus the fibroids are located
- The experience of the surgeon
Are there different types of myomectomy?
There are three main types of myomectomy:
- Open myomectomy
- Minimally invasive laparoscopic myomectomy
- Hysteroscopic myomectomy
An open myomectomy, also known as abdominal myomectomy, is done through an incision in the abdomen. The incision may go up and down or across like a bikini cut. This type of procedure may be the best option for extremely large fibroids, though many times this can be done in a minimally invasive way as well. Recovery after an open myomectomy is similar to any other major surgery. Recovery will include:
- A few days in the hospital
- Up to six weeks at home before you feel 100%
Possible complications of an open myomectomy can include:
- Damage to other organs
- Anesthetic (pain-numbing medications used during surgery) mishaps
These complications are uncommon and your healthcare team will make every effort to avoid these problems.
There are several types of minimally-invasive options for a myomectomy. These surgeries generally have quicker recovery times and are easier on your body.
- Standard laparoscopic myomectomy: This procedure uses a small, lighted telescope that is inserted through the belly button (umbilicus). Several other small incisions are made in other places in the abdomen for the placement of special instruments to assist in removing the fibroids. The fibroids themselves are sometimes removed through the vagina, or through the small openings in the abdomen. Some surgeons use a specialized machine (a robot) to finely control the movement of instruments during this type of surgery.
- Single port myomectomy: This surgery uses only one opening near the belly button (umbilicus) for all the instruments. This results in a slightly larger incision in the belly button, but no other openings on the abdominal wall.
- Hysteroscopic myomectomy: This procedure requires no incisions at all. When fibroids are in just the right place within the uterus, a camera with a specialized attachment can be placed through the vagina into the uterus to remove fibroids.
All of these minimally-invasive approaches have similar outcomes and complications.
Risks / Benefits
What are the complications of fibroid treatments?
All surgeries have the potential for complications. Because of this, non-surgical treatment options are typically used first for fibroids. Non-surgical treatments may include:
- Watchful waiting
- Medications (commonly that affect the menstrual cycle, like birth control pills)
- IUD (intrauterine device used for long-term birth control and can sometimes include hormones)
Other less invasive options include shrinking the fibroids using medications or a blood vessel blocking procedure done by a radiologist (healthcare provider who looks at imaging like X-Rays). A small vaginal surgery can also be done to remove just one or two fibroids, if they are in the correct location.
What are some of the risks of myomectomy?
It is rare, but you can get an infection after the myomectomy procedure. If this happens, you will be given antibiotics. It is fairly common to get a fever after myomectomy, but this usually has more to do with tissue changes than with infection.
If there is serious bleeding with a myomectomy, no matter which type of procedure, a transfusion is sometimes needed. Again, this is unusual. It is best to correct any anemia you may have before surgery, in order to avoid transfusion.
Any damage to other organs will be fixed as soon as it is recognized. Problems with anesthesia will likewise be handled during the operation itself.
If you become pregnant after myomectomy, the recommendations will vary depending on how deep the fibroids were. If any spanned a large part of the wall of the uterus, a cesarean section will be needed for delivery.
Recovery and Outlook
What is the recovery like after myomectomy?
Recovery depends on the type of procedure you have. It also depends on whether or not any problems arise. With an open myomectomy, full recovery before getting back to your normal activities can take up to six weeks. After a laparoscopic myomectomy, you may stay overnight in the hospital and then return home. Recovery at home is about two to four weeks. If the procedure is done hysteroscopically (through the vagina without incisions), full recovery can be just a matter of days.
Can fibroids come back after myomectomy?
New fibroids may grow after a myomectomy. Younger women with many fibroids are at greater risk of getting more fibroids than are women who are near menopause and those with few fibroids.