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 that removes fibroids from a woman’s uterus without removing the uterus itself. This allows women who still want to have children to avoid a hysterectomy and keep their uterus intact.
There are 4 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 take steps to minimize it.
2. A robotic or laparoscopic myomectomy is a less invasive option that uses a few small incisions (each about 5–12 millimeters) instead of one large incision. This approach is often used when fibroids are smaller or easier to access and typically results in less pain and blood loss than an abdominal procedure.
3. In some cases, a myomectomy may also be performed using the vNOTES approach. This technique allows the surgeon to operate through the vaginal canal using specialized instruments, avoiding external abdominal incisions. It offers benefits like less pain, no visible scarring, and a quicker recovery for the right candidates.
4. A hysteroscopic myomectomy accesses fibroids through the vagina and cervix. This method does not require any incisions but is only suitable for certain types of fibroids located inside the uterus.
General anesthesia is typical for most types of myomectomy, although some hysteroscopic procedures may use lighter sedation. In certain cases, local or spinal anesthesia may also be an option.
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.
