Myomectomy
Removing uterine fibroids—not your ability to get pregnant
If you have uterine fibroids, your doctor may recommend a myomectomy, a procedure 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. 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.
The three ways to perform a myomectomy are:
Hysteroscopy
A hysteroscopy is a technique used to remove smaller uterine fibroids that are located in the cavity of the uterus. Your surgeon will insert a long, thin instrument 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 located on the outside or within the wall of the uterus. Your surgeon will use a long, thin instrument to see inside the pelvic area. First, your surgeon will make a small incision in your abdomen to insert the laparoscope. Next, small incisions will be made to insert the instruments used to remove 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.
Overview
Depending on the size and location of your uterine fibroids, your doctor may recommend one of three ways to perform a myomectomy. 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.
The three ways to perform a myomectomy are:
Hysteroscopy
A hysteroscopy is a technique used to remove smaller uterine fibroids that are located in the cavity of the uterus. Your surgeon will insert a long, thin instrument 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 located on the outside or within the wall of the uterus. Your surgeon will use a long, thin instrument to see inside the pelvic area. First, your surgeon will make a small incision in your abdomen to insert the laparoscope. Next, small incisions will be made to insert the instruments used to remove 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.
Be sure to arrive at the hospital on time on the day of your surgery.
Once you arrive, you will be taken to an exam room to change into a hospital gown. You will then meet with your surgeon, 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. They will prep you for either general 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.
A nurse will sterilize the surgical site. 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.
Preparing for a Myomectomy
Prior to your myomectomy, your doctor will determine if any blood tests or imaging studies need to be performed prior to surgery. It is important that you complete these tests. 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 counts.
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 week, day or night before surgery
- Not eating anything after midnight the night before surgery. Anesthesia guidelines allow drinking very small sips of clear fluids up to two hours before surgery. Clear fluids include water, electrolyte drinks, black tea or black coffee.
Recovery
Your expected hospital stay will depend on the type of myomectomy you have:
- Laparotomy (abdominal myomectomy): usually one to two days
- Laparoscopic and hysteroscopic myomectomies: These are usually outpatient surgeries, so you return home the same day as surgery.
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 two weeks. It will take two to four 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. Once you have recovered from surgery, you will return to routine care with your doctor.
What to Expect
Be sure to arrive at the hospital on time on the day of your surgery.
Once you arrive, you will be taken to an exam room to change into a hospital gown. You will then meet with your surgeon, 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. They will prep you for either general 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.
A nurse will sterilize the surgical site. 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.
Preparing for a Myomectomy
Prior to your myomectomy, your doctor will determine if any blood tests or imaging studies need to be performed prior to surgery. It is important that you complete these tests. 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 counts.
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 week, day or night before surgery
- Not eating anything after midnight the night before surgery. Anesthesia guidelines allow drinking very small sips of clear fluids up to two hours before surgery. Clear fluids include water, electrolyte drinks, black tea or black coffee.
Recovery
Your expected hospital stay will depend on the type of myomectomy you have:
- Laparotomy (abdominal myomectomy): usually one to two days
- Laparoscopic and hysteroscopic myomectomies: These are usually outpatient surgeries, so you return home the same day as surgery.
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 two weeks. It will take two to four 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. Once you have recovered from surgery, you will return to routine care with your doctor.
Long-term Prognosis
After myomectomy, you may have relief from symptoms like 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 can 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.
Frequently Asked Questions
How fast do fibroids grow back after myomectomy?
Fibroids can grow back within a few months or even years after a myomectomy, or they may never return at all. After a myomectomy, studies show that between 15 to 33% of fibroids return. If you have multiple fibroids removed, you are more likely to develop new ones in the future. You are also at increased risk of future fibroids if you have high estrogen levels or have fibroids removed at a younger age.
How long does a myomectomy procedure take?
A myomectomy procedure can last anywhere from one to four hours. The length of time depends on what type of procedure you are having, how many fibroids need to be removed and where they are located. A hysteroscopy often lasts 30 to 45 minutes, a laparoscopic myomectomy can take two to four hours and a laparotomy is usually one to two hours.
When can I start having sex after myomectomy?
Ask your doctor when it is safe to begin having sex or using tampons after a myomectomy.
Why is the first period after myomectomy sometimes heavy?
You may have a heavier or irregular period right after a myomectomy because your uterus is still healing from the surgery. This first period can vary depending on the kind of myomectomy you had and how many fibroids were removed. You may see lighter periods and less pain at first, and your periods should return to normal.
How long after a myomectomy can you get pregnant?
It is recommended to wait three months after a myomectomy to get pregnant. This waiting period gives your uterus time to heal and avoid complications during pregnancy.