Myomectomy is a surgery which removes the fibroids from the uterus. Myomectomy allows the uterus to be left in place and for some women the surgery makes pregnancy more likely than before. Myomectomy is the approved fibroid treatment for women that want to become pregnant. Chances of pregnancy may be improved after myomectomy but is 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.
- A lighted viewing instrument is used in Laparoscopy and one or more small cuts (incisions) are made 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 performed to discard fibroids which are on the inner wall of the uterus that have not grown deep into the uterine wall.
- Laparoscopy is generally conserved 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 and to repair these problems without causing organ damage, laparotomy is usually needed.
What to Expect after Myomectomy
The amount of time anyone may spend in the hospital varies.
- Hysteroscopy is an outpatient procedure.
- Laparoscopy may be a procedure which requires a stay of 1 day.
- Laparotomy requires an average stay of 1 to 4 days.
Recovery time depends on the following methods used for myomectomy:
- Hysteroscopy generally takes few days to 2 weeks to recover.
- Laparoscopy generally takes 1 to 2 weeks.
- Laparotomy generally takes 4 to 6 weeks.
Why Myomectomy Is Done?
Myomectomy preserves the uterus while treating fibroids. Myomectomy may be a reasonable treatment option if you have:
How Well Myomectomy Works?
Myomectomy lowers down pelvic pain and prevent bleeding from fibroids.
Myomectomy is a fibroid treatment option that can improve chances of having a baby. It is known to help with a certain kind of fibroid called a sub mucosal fibroid.
After myomectomy, a cesarean section may be needed for delivery. This will generally depend on where and how big the myomectomy incision is.
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. Talk to your doctor about whether your type of fibroid is likely to grow back.
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 abruption or placenta accreta. During labor, the uterus may not function normally, which can make a cesarean delivery necessary.
In rare cases, a hysterectomy procedure is needed when the surgery reveals that the uterus is too overgrown with fibroids for a safe myomectomy.