Myomectomy

Myomectomy is the surgical removal of fibroids from the uterus. It allows the uterus to be left in place and preserves fertility. Myomectomy is the preferred fibroid treatment for women who want to become pregnant.

Before myomectomy, shrinking fibroids with gonadotropin-releasing hormone analogue (GnRH-a) therapy may reduce blood loss from the surgery. GnRH-a therapy is also used to improve aneimia before surgery by stopping uterine bleeding for several months.

Surgical methods for myomectomy include:

- Hysteroscopy, which involves inserting 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 inches across, that are growing on the outside of the uterus.
- Laparotomy is used to remove large fibroids, many fibroids at once, 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.

- Hysterectomy 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 form a few days to 2 weeks to recover
- Laparoscopy requires 2 to 4 weeks.
- Laparotomy requires 4 to 6 weeks.

Why it is done:

Myomectomy preserves the uterus while treating fibroids. It may be 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.
- Fibroids that may be causing infertility or repeat miscarriages. Before an in viro fertilization, myomectomy is often done to improve the chances of pregnancy.

How well it works:

Myomectomy decreases pelvic pain and bleeding from fibroids.

Pregnancy. Of women who have a myomectomy for infertility (and who have no other known cause of infertility), 60% then become pregnant. Myomectomy may also lower the risk of miscarriage among women with fibroids. After myomectomy, a cesarean section can 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% of women, depending on the original fibroid problem. Fibroids that were larger and more numerous are most likely to recur. Talk to your doctor about whether your type of fibroid is likely to grow back.

Risks include the following:

- Infection of the uterus, fallpian tubes, or ovaries (pelvis 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.

What to think about:

When trying to get pregnant after a myomectomy. Because fibroids can grow back, it is best to try to conceive as soon after a myomectomy as is safely possible. Experts recommend:

- Waiting 4 to 6 months after surgery to allow the uterus to heal before pregnancy.
- A hysterosalpingogram after 4 months to check the uterus and fallopian tubes before any infertility treatment.

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

On rare occasions, a hysterectomy becomes necessary when the surgery reveals that the uterus is too overgrown with fibroids for a safe myomectomy.