Overview of Myomectomy Procedure

Everything you need to know about the procedure and recovery time

Uterine fibroids are common among women at every age (particularly women during childbearing years), but they’re generally harmless and noncancerous. Smaller fibroids are often simply left alone and monitored by your OB-GYN, but larger ones have to be removed through a procedure called a myomectomy.

If larger ones are not removed, they can affect fertility and begin to push on your uterus or take up space, causing a growing fetus to experience possible complications.

The downside is that even if you have all fibroids removed, there’s a possibility they’ll grow back.

What is a myomectomy?

A myomectomy is a gynecological surgery procedure that removes fibroids from a woman’s uterus without having to remove the uterus itself. This option allows women who still want to have children to avoid a hysterectomy, keeping their uterus intact.

There are 3 primary methods used to perform a myomectomy:

1. An abdominal myomectomy requires a larger incision (about 4 inches) along your lower abdomen (think bikini line) that requires stitches or staples to close. It can cause some blood loss, but doctors do everything they can to minimize it.

2. A robotic or laparoscopic myomectomy is a less invasive procedure that requires a few smaller incisions (each only about 5-12 millimeters) without leaving a large myomectomy scar. If the fibroids are smaller or closer to the surface of the uterus, a surgeon may be able to remove them through this method. One study found that a laparoscopic myomectomy caused significantly less pain and blood loss than an abdominal myomectomy.

3. A hysteroscopic myomectomy involves accessing the fibroids through the vagina and cervix. This procedure doesn’t require an incision but can only be used for certain types of fibroids.

General anesthesia is typical for all 3 types of surgery, although monitored anesthesia that doesn’t require a breathing tube might be used for a hysteroscopic procedure. Local or spinal anesthesia can be used in some cases as well.

When is a myomectomy procedure necessary?

Women with fibroids often experience bothersome symptoms that can make everyday life difficult. Pelvic pressure that becomes painful at times and frequent urination are 2 common signs. Heavy menstrual bleeding accompanied by increased pain can be another symptom.

Fibroids can also interfere with a woman's fertility, possibly causing miscarriages. Although there are hormonal treatments that can shrink fibroids, they’re usually intended to allow for less-invasive surgeries, rather than eliminate the need for surgery altogether.

What are some possible complications of a myomectomy?

Myomectomy complications are rare, but anyone undergoing this procedure should be aware of the potential risks and complications just the same. Some of the possible risks include:

Spreading a cancerous tumor if the fibroid is misdiagnosed
An impromptu hysterectomy due to abnormalities or bleeding
Damage to organs close to your uterus
Complications during pregnancy or childbirth, often making a cesarean section (C-section) necessary

Uterine perforation
Adhesions, especially in abdominal surgery
Excessive blood loss
Infections that require antibiotic treatment
New fibroids, possibly in another location

Hysteroscopic and laparoscopic procedures are generally outpatient surgeries. When an abdominal myomectomy is performed, a 1 to 2-day stay in the hospital is typical. Patients will require someone to drive them home and watch for complications.

Can I get pregnant after a myomectomy?

If infertility has been an issue, the procedure can help increase the chances of a successful pregnancy. However, pregnancy after a myomectomy can come with an increased risk of complications. Having had past fibroids is a risk factor on its own.

Depending on where your surgeon had to make the incisions, you may have to deliver your future babies via a C-section. Having a C-section instead of a vaginal delivery helps reduce the risk of a ruptured uterus during childbirth.

How long is the myomectomy recovery process?

Most doctors will prescribe pain medication following this procedure, as well as provide myomectomy recovery tips to help promote better healing. There might be vaginal bleeding or spotting for a few weeks. This bleeding or spotting is normal.

You might also have some restrictions for a short time after the surgery:

A hysteroscopic myomectomy has the shortest recovery time of 2-3 days.
A laparoscopic myomectomy has a 2-4 week recovery time.
An abdominal myomectomy has the longest recovery time, lasting 4-6 weeks.

Take your doctor's advice about when to resume certain activities seriously. Sexual activity may require waiting for up to 6 weeks. Strenuous exercise or heavy lifting should also be avoided until all incisions have healed.

Do you have questions about having a myomectomy procedure?

If you have or suspect you're having issues related to fibroids, talk to an experienced OB-GYN to find out if a myomectomy might be right for you. If you live in North Florida, consider scheduling an appointment at All About Women Obstetrics and Gynecology to learn more about having this procedure done.