Myomectomy

Surgery Overview

Myomectomy is surgery to remove fibroids from the uterus. It allows the uterus to be left in place. For some women, it makes pregnancy more likely than before. It 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. This treatment 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.

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 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.

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

Current as of: February 11, 2021

Author: Healthwise Staff
Medical Review:
Sarah Marshall MD - Family Medicine
Kathleen Romito MD - Family Medicine
Martin J. Gabica MD - Family Medicine
Divya Gupta MD - Obstetrics and Gynecology, Gynecologic Oncology