Myomectomy

What is a Myomectomy?

Myomectomy is a surgical procedure to remove uterine fibroids, which are benign or non-cancerous growths appearing in the uterus.

Many women with uterine fibroids do not experience any symptoms. However, some women may experience heavy and prolonged menstrual bleeding, anaemia due to heavy menstrual bleeding, pelvic pain, lower back pain, or bloating of the abdomen. In other cases, women may have difficulty emptying their bladders, difficulty moving the bowels and reproductive problems such as infertility.

Myomectomy is the treatment of choice in women with problematic fibroids who are planning to have children in the future. Myomectomy removes only the fibroids and leaves the uterus intact and may increase the chances of pregnancy depending on where the fibroids are situated. You may need to have a caesarean section after a myomectomy.

Indications for Myomectomy

A myomectomy is a treatment option if you have problematic fibroids but you want to keep your uterus. A hysterectomy is usually the best treatment for fibroids in women who have completed their families because there is less risk of major blood loss.  Myomectomy is also done if the fibroids have changed the shape of the uterus and is thought to cause infertility or repeated miscarriages.  Even if all visible fibroids are removed, they can recur.

Preparation Before Surgery

If there are many fibroids or they are large we may prescribe a medication called gonadotropin-releasing hormone analogues (GnRH-a)  which lowers oestrogen levels and may shrink the uterine fibroids.  It also reduces the risk of excessive bleeding during surgery.

Myomectomy Procedure

Depending on the size, location, and number of fibroids, your surgeon may choose one of three surgical approaches to remove the fibroids:

• Hysteroscopy: This is performed under general anaesthesia or spinal anaesthetic. Fibroids located inside the cavity of the uterus and are not too deep within the wall of the uterus can be removed using this technique.
• Laparoscopy: This procedure is the preferred option to remove one or two small to moderate size fibroids that grow on the outside of the uterus.
• Laparotomy: A laparotomy for myomectomy is the surgical removal of fibroids through a large incision in the lower abdomen. If the fibroids are large, there are many in number or they are deep into the uterine wall your doctor may opt for laparotomy.

Complications

The possible complications of myomectomy include

• bleeding
• infection
• scar tissue formation
• damage to the bladder, bowel or ureters
• rupture of the uterine scars in late pregnancy or during labour. Rarely, a myomectomy causes uterine scarring that can lead to infertility.

Because fibroids can grow back, those women who are planning to become pregnant in the future should try to conceive soon after the myomectomy procedure. However, we advise you to wait for 4 to 6 months until the uterus heals.