Myomectomy is a surgery performed to eliminate fibroids from the uterus. The uterus is sometimes prone to such common benign (noncancerous) growths. Although these uterine fibroids can develop at any age, they mostly form during a woman's reproductive years.
During a myomectomy, the aim is to remove symptoms triggering fibroids and restructure the uterus. A myomectomy, unlike a hysterectomy, which involves removing the whole uterus, only removes the fibroids while leaving your uterus. The females who have a myomectomy report less heavy menstrual flow and lower pelvic pressure, as well as a reduction in other fibroid symptoms.
Reasons for Myomectomy
If you have fibroids that are bothering you or interfering with your daily activities, your gynecologist may suggest a myomectomy. Therefore, if you require surgery, there are several reasons to opt for a myomectomy for uterine fibroids rather than a hysterectomy. Some of these reasons include;
- Your desire to start a family.
- Uterine fibroids may be affecting your fertility, according to your doctor.
- You wish to retain the uterus.
Ideal Candidates for Myomectomy
Women who have fibroids yet desire to conceive in the future or maintain their uterus for some other reasons may consider myomectomy. It aims at eliminating your fibroids and leaving your uterus intact. This gives you the chance of having children in the future.
Depending on the exact location and size of your fibroids, your doctor may recommend one of the following types of myomectomy:
- Abdominal myomectomy: This could be suitable if you have several or extremely large fibroids developing in your uterine wall.
- A laparoscopic myomectomy: This might be a good option, especially if you have small and fewer fibroids.
- A hysteroscopic myomectomy: Your doctor can recommend this option if you have small fibroids in your uterus.
How to Prepare For Myomectomy
Before surgery, your doctor will schedule an appointment with you to go over the procedure as part of the preparation. Therefore, ensure that you talk about all the concerns you have regarding preparation and what you should expect from your surgery.
Your provider may also give you some medicine to lessen the size of the fibroids before the myomectomy procedure. This makes it much easier to remove. For instance, gonadotropin-releasing hormone agonists, including leuprolide (Lupron), inhibit estrogen and progesterone production. They thus induce temporary menopause in you. However, your menstrual cycle will return as soon as you stop using these drugs, and pregnancy should be possible.
In addition, you may be required to undergo some testing to ensure that you are fit for surgery. Depending on your risk factors, the doctor will choose the suitable tests you require. They can include the following;
- Blood tests
- Magnetic resonance imaging (MRI)
- Pelvic ultrasound
Also, your doctor may ask you to stop using certain drugs a few days before surgery. Be sure to inform him or her about all your medications. This includes supplements, vitamins, or over-the-counter medicines.
Quit smoking at least six to eight weeks prior to your procedure if you are a smoker. This is because smoking has been shown to impede the recovery process and raise the possibility of cardiovascular events in surgery. If necessary, seek guidance from your doctor on how to stop smoking.
How Myomectomy is performed
Based on the location, number, and size of the fibroids, the surgical approach will vary. The physician will thus perform any of the following myomectomy procedures;
- Abdominal myomectomy
With abdominal myomectomy, you will receive general anesthesia. The surgeon will then start by creating an incision into the uterus through the lower abdomen. This can be accomplished in a number of ways, including;
- Making a horizontal incision about three to four inches long above the pubic bone. This sort of incision is usually less painful and leaves behind a small myomectomy scar. However, it may be insufficient to take out larger fibroids.
- Making a vertical incision right from below the belly button towards the top of the pubic bone. This incision is rarely utilized nowadays, though it may be preferable for larger fibroids and the need to reduce bleeding.
The surgeon will take out the fibroids from the uterine wall after the incision creation is done. After that, the uterine muscle layers are stitched back together. In most cases, women who undergo abdominal myomectomy often spend one or three days in the medical facility.
- Laparoscopic myomectomy
During laparoscopic myomectomy, the surgeon creates four tiny incisions while you are under general anesthesia. In your lower abdomen, these incisions will each be roughly 0.5 inches long. He or she will then fill your stomach with carbon dioxide gas in order to make the inside structures visible.
The next step involves inserting a laparoscope in one of the cuts. The laparoscope is a tiny, illuminated tube attached to a camera at one of its ends. The other incisions will have small devices in them.
The surgeon will then use a robotic arm to control the devices if the procedure is being conducted robotically. Alternatively, he or she may slice the fibroids into smaller pieces so as to take them out. In case the fibroids are too big, the surgeon may recommend an abdominal myomectomy, which involves a larger abdominal incision.
Once the procedure is complete, the surgeon will take out the devices, release the carbon dioxide gas, and close up the incisions. The majority of women who undergo this operation often spend one night in the hospital.
- Hysteroscopic myomectomy
During this operation, your surgeon will give you local anesthesia or administer general anesthesia. He or she will then put a small, illuminated scope into the uterus via the vagina and cervix.
They will inject a liquid into the uterus to enlarge it and make it easier to see the uterine fibroids. Once visible, the surgeon will shave off portions of the fibroid using a wire loop. The liquid will then wash away the fibroid bits that have been removed.
In most cases, women who undergo hysteroscopic myomectomy should return home on that same day.
You are likely to experience some pain and discomfort during myomectomy recovery. The doctor may thus prescribe medicine to help alleviate your discomfort. For a few days or weeks, you will also notice spotting.
The length of time you need to wait before resuming your usual activities is determined by the procedure type you had. Whereas the recuperation time for open surgery is usually the longest, the following are the recovery times for every myomectomy surgery;
- Four to six weeks for abdominal myomectomy
- Two to four weeks for a laparoscopic myomectomy
- Two to three days for hysteroscopic myomectomy
Lifting heavy objects or engaging in intense exercise should be avoided until the incisions heal completely. In most cases, your doctor will tell you when to resume such activities. Also, inquire about the duration you will have to wait before you can have sex. It's possible that you'll have to wait for about six weeks.
In case you wish to start trying for a baby, talk to your doctor about when it's safe to do so. Depending on the type of surgery you underwent, you may have to wait three to six months for the uterus to recover fully.
Complications of Myomectomy
Generally, myomectomy is associated with a low rate of complications. Nonetheless, the treatment comes with its own set of difficulties. The following are some of the risks of myomectomy;
Scar tissue: Adhesions (bands of scar tissue that form after surgery) can develop into uterus incisions. When compared to abdominal myomectomy, laparoscopic myomectomy may result in fewer adhesions.
Excess blood loss: Most women who have uterine leiomyomas already have reduced blood counts (or anemia) due to severe menstrual bleeding. This puts them at a high risk of complications from blood loss. Therefore, before surgery, your doctor may recommend strategies to help boost your blood count.
Complications during pregnancy or delivery: If you get pregnant after a myomectomy, you may face increased risks during childbirth. If the surgeon creates a large cut in your uterine wall, the physician supervising your subsequent pregnancy may suggest a cesarean birth (C-section). This is basically to avoid uterine rupture during labor, which is an extremely rare pregnancy problem.
A possibility of hysterectomy: When bleeding is unmanageable, or other abnormalities are discovered apart from fibroid, the surgeon may have to eliminate the uterus.
A rare possibility of spreading malignant tumor: A malignant tumor can occasionally be confused for a fibroid. Hence, the removal of the tumor, particularly if it's fragmented into small pieces to fit through a tiny incision, can cause the malignancy to spread. This is more likely to happen after menopause or as women get older.
Myomectomy refers to the surgical removal of fibroids from the uterus. It enables the uterus to remain in position and, for certain women, increases their chances of conception. For women who wish to get pregnant, myomectomy is generally the preferred fibroid treatment.
Although the chances of getting pregnant after a myomectomy may improve, they are not guaranteed. Therefore, your doctor will discuss with you in advance the benefits and the possible outcome of the procedure.