Myomectomy
Removing uterine fibroids—not your ability to get pregnant
Uterine fibroids can cause symptoms including excessive bleeding, pelvic pain and pressure and frequent urination.
If you have uterine fibroids, your doctor may recommend a myomectomy, a minimally invasive procedure used to remove uterine fibroids.
Unlike a hysterectomy, a myomectomy leaves the healthy parts of the uterus intact and may preserve your ability to get pregnant.
Depending on the size and location of your uterine fibroids, your doctor may recommend one of three ways to perform a myomectomy.
Hysteroscopy
A hysteroscopy is a technique used to remove smaller uterine fibroids through the vagina. Your surgeon will insert a long, thin telescope with a light and camera at the end called a hysteroscope through your vagina and cervix and into the uterus. Next, fluid is injected into the uterus to make it easier to see the fibroids. Your surgeon then uses a small tool to remove the fibroids.
Laparoscopy
A laparoscopy is a technique used to remove fibroids from outside the uterus. Your surgeon will use a long, thin telescope to see inside the pelvic area. First, your surgeon will make a small incision in your abdomen to insert the laparoscope and a second incision to insert the surgical tool that removes the fibroids. Next, small incisions are also made in the uterus to gain access to the fibroids.
Laparotomy
Also called an abdominal myomectomy, a laparotomy is a procedure that involves removing uterine fibroids directly through an incision in your abdomen. This procedure can be used to remove both large and small fibroids, in any location. Your surgeon will make a horizontal incision at the bikini line or a vertical incision between the navel and the pubic bone. Then, incisions are made in the uterus to remove each fibroid.
In some cases, myomectomy techniques may be combined. For example, a laparoscopy may be performed along with a mini laparotomy, or hysteroscopy and laparoscopy may be used to remove fibroids attached to the outer and inner walls of the uterus.
Myomectomy Procedure
Be sure to arrive at the hospital on time on the day of your surgery.
Once you arrive, you will be taken to a room where you will change into a hospital gown. You will then meet with your surgeon, the nurses and an anesthesiologist in the room. Be sure to ask any questions you still have about the procedure.
An anesthesiologist will insert an intravenous (IV) line in your arm or wrist to deliver fluids and pain medicine and prep you for either general or spinal anesthesia so that you feel no pain during the surgery.
Once you are ready for surgery, you will be moved to the operating room. The surgery team will monitor your heart rate, blood pressure and breathing during the procedure.
If you are undergoing a laparoscopy or laparotomy, a nurse will sterilize the areas where the incisions will be made. Then, the surgeon will numb the incision site or sites with a local anesthetic.
After the surgeon removes the fibroids, he or she will repair any incision sites in the uterus. Any other incision sites on the abdomen or bikini line are sutured and covered with a dressing.
Immediately after surgery, you will be moved to a recovery room where a nurse will monitor your vital signs as you wake up. You will be given pain medicine to help you feel better. The surgeon will encourage you to get out of bed and move around as soon as possible to speed recovery and prevent blood clots in your legs.
What to Expect
Depending on the size and location of your uterine fibroids, your doctor may recommend one of three ways to perform a myomectomy.
Hysteroscopy
A hysteroscopy is a technique used to remove smaller uterine fibroids through the vagina. Your surgeon will insert a long, thin telescope with a light and camera at the end called a hysteroscope through your vagina and cervix and into the uterus. Next, fluid is injected into the uterus to make it easier to see the fibroids. Your surgeon then uses a small tool to remove the fibroids.
Laparoscopy
A laparoscopy is a technique used to remove fibroids from outside the uterus. Your surgeon will use a long, thin telescope to see inside the pelvic area. First, your surgeon will make a small incision in your abdomen to insert the laparoscope and a second incision to insert the surgical tool that removes the fibroids. Next, small incisions are also made in the uterus to gain access to the fibroids.
Laparotomy
Also called an abdominal myomectomy, a laparotomy is a procedure that involves removing uterine fibroids directly through an incision in your abdomen. This procedure can be used to remove both large and small fibroids, in any location. Your surgeon will make a horizontal incision at the bikini line or a vertical incision between the navel and the pubic bone. Then, incisions are made in the uterus to remove each fibroid.
In some cases, myomectomy techniques may be combined. For example, a laparoscopy may be performed along with a mini laparotomy, or hysteroscopy and laparoscopy may be used to remove fibroids attached to the outer and inner walls of the uterus.
Myomectomy Procedure
Be sure to arrive at the hospital on time on the day of your surgery.
Once you arrive, you will be taken to a room where you will change into a hospital gown. You will then meet with your surgeon, the nurses and an anesthesiologist in the room. Be sure to ask any questions you still have about the procedure.
An anesthesiologist will insert an intravenous (IV) line in your arm or wrist to deliver fluids and pain medicine and prep you for either general or spinal anesthesia so that you feel no pain during the surgery.
Once you are ready for surgery, you will be moved to the operating room. The surgery team will monitor your heart rate, blood pressure and breathing during the procedure.
If you are undergoing a laparoscopy or laparotomy, a nurse will sterilize the areas where the incisions will be made. Then, the surgeon will numb the incision site or sites with a local anesthetic.
After the surgeon removes the fibroids, he or she will repair any incision sites in the uterus. Any other incision sites on the abdomen or bikini line are sutured and covered with a dressing.
Immediately after surgery, you will be moved to a recovery room where a nurse will monitor your vital signs as you wake up. You will be given pain medicine to help you feel better. The surgeon will encourage you to get out of bed and move around as soon as possible to speed recovery and prevent blood clots in your legs.
Prior to your myomectomy, your doctor will order a blood test to make sure you are healthy enough for surgery and imaging tests to determine the size and location of the uterine fibroids. You may also need to take medicines or hormone treatments to shrink the fibroids before surgery.
Some doctors prescribe leuprolide (Lupron) two to six months before surgery. In addition to helping reduce the size of the fibroids, leuprolide stops menstruation, which allows anemic patients to improve their blood count. It also reduces the risk of excess blood loss during surgery.
Be sure to tell your doctor about all the medicines you take before surgery, including any over-the-counter medicines and supplements.
Follow your doctor’s instructions for the night before surgery. This may include:
- Not taking certain medicines the night before or day of surgery.
- Not eating or drinking after midnight the night before surgery.
Preparing for a Myomectomy
Prior to your myomectomy, your doctor will order a blood test to make sure you are healthy enough for surgery and imaging tests to determine the size and location of the uterine fibroids. You may also need to take medicines or hormone treatments to shrink the fibroids before surgery.
Some doctors prescribe leuprolide (Lupron) two to six months before surgery. In addition to helping reduce the size of the fibroids, leuprolide stops menstruation, which allows anemic patients to improve their blood count. It also reduces the risk of excess blood loss during surgery.
Be sure to tell your doctor about all the medicines you take before surgery, including any over-the-counter medicines and supplements.
Follow your doctor’s instructions for the night before surgery. This may include:
- Not taking certain medicines the night before or day of surgery.
- Not eating or drinking after midnight the night before surgery.
Your expected hospital stay will depend on the type of myomectomy you have:
- Laparotomy (abdominal myomectomy): usually two to three days
- Laparoscopic and hysteroscopic myomectomies: usually overnight
Some hysteroscopic myomectomies do not require an overnight stay.
You should expect some vaginal spotting for up to six weeks depending on the type of myomectomy performed. If you had a laparoscopic or hysteroscopic myomectomy, you can expect to fully recover in one to three weeks. It will take four to six weeks for you to fully recover and return to normal activities after an abdominal myomectomy.
You will see your surgeon for a follow-up visit two to six weeks after the myomectomy to monitor your recovery and check for any new fibroids. You will also have a pelvic exam and/or ultrasound three months, six months and one year after the myomectomy to check for fibroids. If no new fibroids are found after one year, your doctor will likely recommend annual exams.
Long-term prognosis
After myomectomy, you can expect relief from symptoms including heavy menstrual bleeding and pelvic pain and pressure. While the original fibroids do not regrow after surgery, it is possible for new fibroids to appear, and they may or may not require treatment. If you only had one fibroid removed, you have a lower risk of needing treatment for any new fibroids.
Most women who have a myomectomy are able to become pregnant. However, you should wait three months after the procedure before trying to become pregnant. In some cases, the baby may need to be delivered by cesarean section if the uterine wall is weak.
After Your Procedure
Your expected hospital stay will depend on the type of myomectomy you have:
- Laparotomy (abdominal myomectomy): usually two to three days
- Laparoscopic and hysteroscopic myomectomies: usually overnight
Some hysteroscopic myomectomies do not require an overnight stay.
You should expect some vaginal spotting for up to six weeks depending on the type of myomectomy performed. If you had a laparoscopic or hysteroscopic myomectomy, you can expect to fully recover in one to three weeks. It will take four to six weeks for you to fully recover and return to normal activities after an abdominal myomectomy.
You will see your surgeon for a follow-up visit two to six weeks after the myomectomy to monitor your recovery and check for any new fibroids. You will also have a pelvic exam and/or ultrasound three months, six months and one year after the myomectomy to check for fibroids. If no new fibroids are found after one year, your doctor will likely recommend annual exams.
Long-term prognosis
After myomectomy, you can expect relief from symptoms including heavy menstrual bleeding and pelvic pain and pressure. While the original fibroids do not regrow after surgery, it is possible for new fibroids to appear, and they may or may not require treatment. If you only had one fibroid removed, you have a lower risk of needing treatment for any new fibroids.
Most women who have a myomectomy are able to become pregnant. However, you should wait three months after the procedure before trying to become pregnant. In some cases, the baby may need to be delivered by cesarean section if the uterine wall is weak.
