What is myomectomy?
Myomectomy is a type of surgery used to remove uterine fibroids. Your doctor might recommend this surgery if your fibroids are causing symptoms such as:
- pelvic pain
- heavy periods
- irregular bleeding
- frequent urination
A myomectomy can be done one of three ways:
- Abdominal myomectomy lets your surgeon removes your fibroids through an open surgical cut in your lower belly.
- Laparoscopic myomectomy allows your surgeon to remove your fibroids through several small incisions. This may be done robotically. It’s less invasive and recovery is faster than with abdominal myomectomy.
- Hysteroscopic myomectomy requires your surgeon to use a special scope to remove your fibroids through your vagina and cervix.
Who is a good candidate?
Myomectomy is an option for women with fibroids who wish to get pregnant in the future, or who want to keep their uterus for another reason.
Unlike a hysterectomy, which takes out your entire uterus, myomectomy removes your fibroids but leaves your uterus in place. This allows you to try for children in the future.
The type of myomectomy your doctor recommends depends on the size and location of your fibroids:
- Abdominal myomectomy may be best for you if you have many or very large fibroids growing in your uterine wall.
- Laparoscopic myomectomy may be better if you have smaller and fewer fibroids.
- Hysteroscopic myomectomy may be better if you have smaller fibroids inside your uterus.
How do you prepare for surgery?
Before you have surgery, your doctor may prescribe medication to reduce the size of your fibroids and make them easier to remove.
Gonadotropin-releasing hormone agonists, such as leuprolide (Lupron), are drugs that block production of estrogen and progesterone. They will put you into temporary menopause. Once you stop taking these medications, your menstrual period will return and pregnancy should be possible.
When you meet with your doctor to go over the procedure, make sure you ask any questions you have about preparation and what to expect during your surgery.
You might need tests to make sure you’re healthy enough for surgery. Your doctor will decide which tests you need based on your risk factors. These can include:
- blood tests
- MRI scan
- pelvic ultrasound
You may have to stop taking certain medications before your myomectomy. Tell your doctor about each medication you take, including vitamins, supplements, and over-the-counter medications. Ask your doctor which drugs you’ll need to stop taking before your surgery and how long you’ll need to stay off them.
If you smoke, stop six to eight weeks before your surgery. Smoking can slow your healing process as well as increase your risk of cardiovascular events during your surgery. Ask your doctor for advice on how to quit.
You will need to stop eating and drinking by midnight the night before your surgery.
What happens during the procedure?
The procedure will differ depending on what type of myomectomy you’re having.
During this procedure, you’ll be placed under general anesthesia.
Your surgeon will first make an incision through your lower abdomen into your uterus. This can be done in a couple of ways:
- A horizontal incision 3 to 4 inches long, just over your pubic bone. This type of incision causes less pain and leaves a smaller scar but may not be big enough to remove large fibroids.
- A vertical incision from just below your belly button to just above your pubic bone. This incision type is rarely used today but it may work better for larger fibroids and cuts down on bleeding.
Once the incision is made, your surgeon will remove your fibroids from your uterine wall. Then they’ll stitch your uterine muscle layers back together.
Most women who have this procedure spend one to three days in the hospital.
While you’re under general anesthesia, your surgeon will make four small incisions. These will each be about ½-inch long in your lower abdomen. Your belly will be filled with carbon dioxide gas to help the surgeon see inside your abdomen.
The surgeon will then place a laparoscope into one of the incisions. A laparoscope is a thin, lighted tube with a camera on one end. Small instruments will be placed into the other incisions.
If the surgery is being done robotically, your surgeon will control the instruments remotely using a robotic arm.
Your surgeon may cut your fibroids into small pieces to remove them. If they are too large, your surgeon may change to an abdominal myomectomy and make a larger incision in your abdomen.
Afterward, your surgeon will remove the instruments, release the gas, and close your incisions. Most women who have this procedure stay in the hospital for one night.
You will get a local anesthetic or be placed under general anesthesia during this procedure.
The surgeon will insert a thin, lighted scope through your vagina and cervix into your uterus. They’ll place a liquid in your uterus to widen it to allow them to see your fibroids more clearly.
Your surgeon will use a wire loop to shave off pieces of your fibroid. Then, the liquid will wash out the removed pieces of fibroid.
You should be able to go home the same day as your surgery.
What is recovery like?
You will have some pain after your surgery. Your doctor can provide medication to treat your discomfort. You’ll also have spotting for a few days to weeks.
How long you’ll have to wait before returning to your normal activities depends on what type of procedure you have. Open surgery has the longest recovery time.
Recovery times for each procedure are:
- abdominal myomectomy: four to six weeks
- laparoscopic myomectomy: two to four weeks
- hysteroscopic myomectomy: two to three days
Don’t lift anything heavy or exercise strenuously until your incisions have fully healed. Your doctor will let you know when you can return to these activities.
Ask your doctor when it’s safe for you to have sex. You may have to wait up to six weeks.
If you want to get pregnant, ask your doctor when you can safely start trying. You might need to wait three to six months for your uterus to fully heal depending on which kind of surgery you’ve had.
How effective is it?
Most women get relief from symptoms like pelvic pain and heavy menstrual bleeding after their surgery. However, fibroids can come back after myomectomy, especially in younger women.
What are the complications and risks?
Any surgery can have risks, and myomectomy is no different. Risks of this procedure are rare, but they can include:
- excessive bleeding
- damage to nearby organs
- a hole (perforation) in your uterus
- scar tissue that could block your fallopian tube or lead to fertility problems
- new fibroids that require another removal procedure
Call your doctor if you have any of these symptoms after your procedure:
- heavy bleeding
- severe pain
- trouble breathing
What will the scar be like?
If you have an abdominal myomectomy, your scar will likely be about an inch below your pubic hair line, below your underwear. This scar also fades over time.
Your scar may be tender or feel numb for several months, but this should subside over time. Talk with your doctor if your scar continues to hurt, or if it becomes more sensitive. In some cases, your doctor may recommend reopening the scar so it can heal again.
Scars from a laparoscopic myomectomy may show when wearing a low-cut bikini or a cropped top. These scars are much smaller than those from an abdominal myomectomy and they should also fade over time.
Pictures of myomectomy scars
How will a myomectomy affect future pregnancies?
Your likelihood of pregnancy depends on the type and number of fibroids you have. Women who have more than six fibroids removed are less likely to get pregnant than those who have fewer fibroids removed.
Because this procedure can weaken your uterus, there is a chance that your uterus could tear as your pregnancy progresses or during labor. Your doctor will likely recommend that you have a cesarean delivery to prevent this complication. They may recommend scheduling this shortly before your actual due date.
Your cesarean might be able to be performed through your myomectomy incision site. This can reduce the number of scars you have.
What to expect
If you have uterine fibroids that are causing symptoms, myomectomy can be used to remove them and relieve your symptoms. The type of myomectomy procedure you have depends on the size of your fibroids and where they’re located.
Talk with your doctor to find out if this surgery’s right for you. Make sure you understand all the possible benefits and risks before you decide to go ahead with the procedure.
Q&A: Pregnancy risks after myomectomy
Will pregnancy following a myomectomy be considered high-risk?
There are risks following this procedure, but they can be managed well by communicating with your doctor. You should notify your doctor if you’ve had a myomectomy prior to becoming pregnant. This will be important in terms of when and how you deliver, which is generally recommended as cesarean section, to avoid having your uterus labor. Because your uterus has been operated on, there is some weakness in the uterine muscle. You should let your doctor know if you have uterine pain or vaginal bleeding while pregnant, as this could be a sign of uterine rupture.Holly Ernst, PA-CAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.