Myomectomy surgery is an option for those experiencing painful and uncomfortable symptoms caused by fibroids. A doctor or specialist in fibroid care can help you decide if myomectomy surgery is the best way to treat your uterine fibroids. NewYork-Presbyterian offers world-class doctors and a full scope of care to meet each patient’s unique health needs, from general gynecology to advanced gynecological surgery.
What is a Myomectomy?What is a Myomectomy?
Myomectomy is a surgical procedure used to remove uterine fibroids, also called myomas, from the uterus. Although fibroids are removed during this surgical procedure, the uterus and reproductive organs are preserved. This allows for future pregnancies.
A woman may be a good candidate for myomectomy surgery if her uterine fibroid symptoms cause complications, such as heavy bleeding or abdominal pain. A myomectomy can reduce the bleeding, pain, and discomfort caused by uterine fibroids. However, it is not a cure, as the fibroids may return even after surgery.
Myomectomy vs. hysterectomy
Both hysterectomy and myomectomy surgeries are treatment options for uterine fibroids that are causing bothersome symptoms. Myomectomy surgery removes uterine fibroids while conserving the health and utility of the uterus. For women planning future pregnancies, myomectomy surgery helps protect fertility. Removal of fibroids does not affect a patient’s hormone levels or menopausal status.
Hysterectomy removes the entire uterus; a woman can no longer become pregnant or develop more uterine fibroids after surgery. A hysterectomy can be performed without the removal of the ovaries. If the ovaries are left in place, a hysterectomy does not affect hormones and aging as much.
Speak to your doctor to understand more about the differences between myomectomy and hysterectomy. A conversation can help guide you on how best to treat and remove your uterine fibroids.
Types of MyomectomiesTypes
There are various surgical techniques to consider. These range from laparoscopic myomectomy and robotic techniques to open incision surgery or abdominal myomectomy. The location, size, and number of uterine fibroids may determine the type of procedure your gynecological surgeon may use.
Types of myomectomy procedures include:
- Hysteroscopic myomectomy
- Minimally invasive myomectomy (laparoscopic or robotic-assisted laparoscopic)
- Open incision myomectomy
- Hysteroscopic myomectomy: An incision-less surgery that uses a specialized instrument with a camera, which assists in fibroid removal through the vagina. This surgery offers a short recovery time but is only an option for those with uterine fibroids of certain sizes and in certain accessible locations.
- Minimally invasive myomectomy uses smaller incisions, which means less scarring, and a shorter hospital stay and recovery time. Two types include:
- Standard laparoscopic: Small incisions are made in the belly button and around the abdomen for special instruments, such as lighted telescopes and robotic technology, to be inserted. Fibroids are extracted through the vagina or abdomen.
- Single port laparoscopic: Instead of accessing the uterus through the abdominal wall, the surgeon makes one cut in the belly button and another for instruments to take out the fibroids
- Open or abdominal myomectomy: The surgeon will remove the fibroids through an incision or cut in your lower stomach through the abdomen (called a laparotomy). This surgery is usually for larger fibroids and requires a hospital stay, with a recovery time of about six weeks.
Risks to ConsiderRisks
All surgeries carry a risk of potential complications. Most myomectomy surgeries have low complication and risk rates, but it is still important to understand the unique set of associated risks with having this surgery.
Myomectomy risks include:
- Excessive bleeding during surgery - Fibroids have an abundant blood supply, and removing them can result in bleeding that could require a blood transfusion
- Blood clots - Which may be treated with medication
- Scarring - Caused by a build-up of tissues around the surgical incision site, which may need surgical removal
- Injury to organs – Injuries to organs, such as the intestines or bladder, can occur
- Infection - Treatable with antibiotics
- Pregnancy/birth complications - Due to surgical access to fibroids through the uterine wall. Complications may require pregnant patients to have a Cesarean delivery to avoid rupturing the uterus during labor, a rare but serious pregnancy complication.
- Hysterectomy - During the surgery to manage excessive bleeding or abnormal fibroids. This is a rare complication.
- Cancer - May be found in a tumor that was thought to be a fibroid, and removing the cancerous tumor may cause the disease to spread, though such cases are rare
Preparing for SurgeryPreparation
Before myomectomy surgery, your doctor may make the following recommendations for your safety and to improve surgical outcomes.
- Medications before surgery to shrink uterine fibroids before your procedure, and anemia medications or iron supplements to treat or correct anemia.
- Avoid food and drink the hours before surgery, to reduce potential complications. Your doctor or a care team provider will provide specific instructions for when to stop eating and drinking.
- Plan for an outpatient or hospital stay, depending on your type of myomectomy procedure. Your hospital may also require a companion for you on the day of your surgery and arrange for transportation.
Recovery after MyomectomyAfter Surgery
Your doctor may prescribe pain medication for you when you are discharged from the hospital and provide care instructions, including what activities to avoid, any restrictions on your diet, and what to expect as you heal. Depending on the type of surgery you had during myomectomy recovery, you may experience vaginal bleeding or spotting that could last a few days to six weeks.
Results of the surgery may include:
- Less abdominal pain
- Less pelvic pain and pressure
- Lighter periods
- Higher fertility rates (once the uterus heals in 3 to 6 months)
Because this surgery removes uterine fibroids while preserving the uterus and reproductive organs, there are no body changes to expect after surgery. Once you have healed, you can resume sexual activity, and your doctor will guide you on when you can try to conceive. Depending on the type of myomectomy you have, your doctor will likely recommend that you have a cesarean section in future pregnancies.
Is pregnancy possible after a myomectomy?
Yes. When your doctor says you have fully healed, you can become pregnant since your uterus and ovaries are protected during myomectomy surgery. Uterine fibroids may have interfered with your ability to become pregnant, and some women may experience improved fertility after the procedure.
How long does a myomectomy take?
The time spent in surgery varies for each individual and depends upon the location, size, and the number of uterine fibroids as well as the type of myomectomy surgery. For less invasive techniques, such as hysteroscopic or minimally invasive (laparoscopic) procedures, surgery times may be shorter compared to open incision or open surgery procedures, where time in surgery is often longer.
How long should I wait for IVF after the myomectomy?
It can be very challenging for couples who have been unable to conceive due to uterine fibroids. Even after myomectomy surgery, some women may continue to have fertility problems. Speak with your doctor to determine when to start IVF treatments based on your health status and find emotional support. Find out more about NewYork-Presbyterian’s exceptional Fertility and Reproductive Assistance program.
How should I sleep after a myomectomy?
You will want to get plenty of rest after your myomectomy procedure. Your abdomen or stomach area may be swollen or tender for several days to weeks, depending on the type of procedure you have had. Your doctor may suggest sleeping on your back or using a pillow or wedge to sleep on your side to increase your comfort.
Myomectomy Surgery at NewYork-Presbyterian
NewYork-Presbyterian offers comprehensive and advanced treatment for women with uterine fibroids. Our expert gynecologists and gynecologic surgeons utilize fertility-sparing techniques and cutting-edge technology to provide the latest fibroid treatments to our patients.
Contact us to make an appointment.