Myomectomy
About this test
Myomectomy (my-o-MEK-tuh-me) is a surgical procedure to remove uterine fibroids — also called leiomyomas (lie-o-my-O-muhs). These common noncancerous growths appear in the uterus. Uterine fibroids usually develop during childbearing years, but they can occur at any age.
Why it's done
Your doctor might recommend myomectomy for fibroids causing symptoms that are troublesome or interfere with your normal activities. If you need surgery, reasons to choose a myomectomy instead of a hysterectomy for uterine fibroids include: You plan to bear children Your doctor suspects uterine fibroids might be interfering with your fertility You want to keep your uterus
Risks and complications
Myomectomy has a low complication rate. Still, the procedure poses a unique set of challenges. Risks of myomectomy include: Excessive blood loss. Many women with uterine leiomyomas already have low blood counts (anemia) due to heavy menstrual bleeding, so they're at a higher risk of problems due to blood loss. Your doctor may suggest ways to build up your blood count before surgery. During myomectomy, surgeons take extra steps to avoid excessive bleeding. These may include blocking flow from the uterine arteries by using tourniquets and clamps and injecting medications around fibroids to cause blood vessels to clamp down. However, most steps don't reduce the risk of needing a transfusion. In general, studies suggest that there is less blood loss with hysterectomy than myomectomy for similarly sized uteruses. Scar tissue. Incisions into the uterus to remove fibroids can lead to adhesions — bands of scar tissue that may develop after surgery. Laparoscopic myomectomy may result in fewer adhesions than abdominal myomectomy (laparotomy). Pregnancy or childbirth complications. A myomectomy can increase certain risks during delivery if you become pregnant. If your surgeon had to make a deep incision in your uterine wall, the doctor who manages your subsequent pregnancy may recommend cesarean delivery (C-section) to avoid rupture of the uterus during labor, a very rare complication of pregnancy. Fibroids themselves are also associated with pregnancy complications. Rare chance of hysterectomy. Rarely, the surgeon must remove the uterus if bleeding is uncontrollable or other abnormalities are found in addition to fibroids. Rare chance of spreading a cancerous tumor. Rarely, a cancerous tumor can be mistaken for a fibroid. Taking out the tumor, especially if it's broken into little pieces (morcellation) to remove through a small incision, can lead to spread of the cancer. The risk of this happening increases after menopause and as women age. In 2014, the Food and Drug Administration (FDA) cautioned against using a laparoscopic power morcellator for most women undergoing myomectomy. The American College of Obstetricians and Gynecologists (ACOG) recommends you talk to your surgeon about the risks and benefits of morcellation.
What to expect
Depending on the size, number and location of your fibroids, your surgeon may choose one of three surgical approaches to myomectomy.
Understanding your results
Outcomes from myomectomy may include: Symptom relief. After myomectomy surgery, most women experience relief of bothersome signs and symptoms, such as excessive menstrual bleeding and pelvic pain and pressure. Fertility improvement. Women who undergo laparoscopic myomectomy, with or without robotic assistance, have good pregnancy outcomes within about a year of surgery. After a myomectomy, suggested waiting time is three to six months before attempting conception to allow your uterus time to heal. Fibroids that your doctor doesn't detect during surgery or fibroids that are not completely removed could eventually grow and cause symptoms. New fibroids, which may or may not require treatment, can also develop. Women who had only one fibroid have a lower risk of developing new fibroids — often termed the recurrence rate — than do women who had multiple fibroids. Women who become pregnant after surgery also have a lower risk of developing new fibroids than women who don't become pregnant. Women who have new or recurring fibroids may have additional, nonsurgical treatments available to them in the future. These include: Uterine artery embolization (UAE). Microscopic particles are injected into one or both uterine arteries, limiting blood supply. Radiofrequency volumetric thermal ablation (RVTA). Radiofrequency energy is used to wear away (ablate) fibroids using friction or heat — for instance, guided by an ultrasound probe. MRI-guided focused ultrasound surgery (MRgFUS). A heat source is used ablate fibroids, guided by magnetic resonance imaging (MRI). Some women with new or recurring fibroids may choose a hysterectomy if they have completed childbearing.
Disclaimer: August is a health information platform and its responses don't constitute medical advise. Always consult with a licenced medical professional near you before making any changes.