Myomectomy For Uterine Fibroids: What to Expect

A myomectomy is surgery performed for the removal of uterine fibroids. Different types of myomectomy procedures are recommended for women based on the number, size, and type of fibroids.

Continue reading to learn more about what to expect if your doctor gave you a recommendation to get a myomectomy for uterine fibroids.

What is myomectomy?

Myomectomy is a surgical treatment recommended for women with uterine fibroids.

Uterine fibroid, also called leiomyomas, is a common condition affecting nearly 75% of women worldwide. Fibroids are abnormal growths of connective tissue and muscle cells in the uterine wall. This growth appears inside or outside the uterus. They are almost always benign or non-cancerous.

Uterine fibroids usually affect females between 30 and 50 years of age. Most patients with single or small fibroids do not have any symptoms. However, the presence of multiple or large fibroids can cause pain and even lead to menstrual problems such as polymenorrhagia (frequent and heavy menstrual bleeding).

In some cases, fibroids can reduce a woman’s chances of conception, especially when the fibroids grow inward into the uterine cavity. Women experiencing increased pain and difficulty conceiving might require a myomectomy to remove fibroids in the uterine wall to relieve pain and other symptoms and improve the chances of pregnancy.

During a myomectomy, the doctors remove uterine fibroids while preserving the tissues in the uterus. This can preserve or improve the women’s chances of getting pregnant in the future.

Hence, Myomectomy is considered a more effective alternative to a hysterectomy, which involves the removal of the uterus and cervix along with the fibroids.

What are the different types of myomectomy procedures?

There are 4 main types of myomectomy:

Abdominal myomectomy (also called open myomectomy)
Minimally invasive laparoscopic myomectomy
Minimally invasive robotic myomectomy
Hysteroscopic myomectomy

The choice of the type of myomectomy suitable for a patient is based on several factors, including:

The size of fibroids
The number of fibroids
The location of the fibroids with respect to the uterine and abdominal cavities

Abdominal myomectomy

Your gynecologist might recommend an abdominal myomectomy if the fibroids are very large or if you have a history of prior surgery that has left a scar, making visualization of pelvic organs with the laparoscopic camera more difficult.

In abdominal myomectomy, a surgeon makes a small cut or incision in the abdomen. The incision may go across (horizontally) or up and down (vertically) the abdominal wall. This type of myomectomy is often the best option for women with extremely large fibroids, as an incision through the abdominal wall allows the surgeon to see all the pelvic organs and remove the fibroid without causing damage.

Abdominal myomectomy recovery

The patients usually need to stay in the hospital for a few days after the procedure.

After leaving the hospital, the person recovers from abdominal myomectomy at home for up to six weeks. It is advisable to avoid heavy lifting and other strenuous activities during this period to ensure a smooth recovery.

Minimally invasive laparoscopic myomectomy

Laparoscopy and robotic myomectomy are minimally invasive procedures performed through one or more small incisions taken on the abdominal wall. These procedures generally have shorter recovery times and a lower risk of complications.

During these procedures, the fibroid is cut into smaller sections and extracted through tiny incisions in the abdomen wall.

Laparoscopic myomectomy

Laparoscopic Myomectomy is a surgical procedure that involves removing the fibroids using a small lighted device with a camera attached to its end called the laparoscope.

During this procedure, the surgeon inserts the laparoscope through an incision in the belly button. Then, several additional tiny incisions are made in the abdomen, through which surgical tools are inserted to remove the fibroids.

This procedure is usually recommended when the diameter of the fibroid exceeds 10 centimeters.

Single port myomectomy is another form of laparoscopic myomectomy in which the surgeon uses only one opening near the belly button to pass all the surgical instruments. This leaves a slightly larger scar on the belly button but no other scar on the rest of the abdomen.

Robotic-assisted laparoscopic myomectomy

Robotic-assisted myomectomy is a relatively simple procedure that allows surgeons to remove fibroids using robotic arms.

During this procedure, a robot is used to control the movement of surgical instruments for higher precision and accuracy. This can help minimize the risk of blood loss and damage to the other organs.

Robotic myomectomy takes a longer time and is more expensive.

Laparoscopic and robotic-assisted myomectomy recovery

Recovery after minimally invasive laparoscopic or robotic-assisted myomectomy takes about 2 to 3 weeks. Patients are usually able to resume their routine activities within a few weeks. They also experience less pain due to smaller cuts compared to abdominal myomectomy.

Hysteroscopic myomectomy

This form of myomectomy requires no incisions. Hysteroscopic myomectomy is suitable when fibroids are in a convenient location in the uterus, allowing the surgeon to pass a device called a hysteroscope into the uterus through the vagina for their removal.

This type of myomectomy takes a shorter duration compared to others.

Hysteroscopic myomectomy recovery

Most women recover from a hysteroscopic myomectomy within a week. They are able to resume their routine activities within 7 to 10 days.

How long does a myomectomy take?

The duration of myomectomy depends on the location of the fibroids, the number of fibroids, and the type of surgery. In most cases, the surgery lasts about two to three hours.

Myomectomy recovery tips

Do not lift heavy objects for the first week after the procedure. You might need to wait longer if you had an abdominal myomectomy.
Avoid sexual intercourse for 6 weeks.
Increase your activity level gradually. Do not jump back into your normal activities abruptly.
Drink fluids and high-fiber foods to improve bowel movements
Eat bland low-fat foods like plain rice, broiled chicken, toast, and yogurt
Consider using a mild laxative if you have constipation
Wear loose comfortable clothing
Take incision care to avoid infections
Eat your normal diet containing adequate nutrients.

What myomectomy complications should I be aware of?

You should watch closely for the possible complications of a myomectomy such as:

Infection
Bright red vaginal bleeding
Increased pain, swelling, warmth, or redness
Pus draining
Damage to organs close to the uterus
Blood clots
Allergic reaction to the anesthetic agent
Lost consciousness
Loose stitches
Increased need for a C-section delivery in future pregnancies
Uterine artery embolization

How can I avoid the complications of a myomectomy?

Myomectomy takes women between 4 to 6 weeks to fully recover. During this period, avoid any strenuous physical activities, such as jogging, swimming, cycling, and heavy lifting objects. Those who return to strenuous activity too soon have reported having passed out, lost consciousness, and needed to seek immediate medical care. Use doctor-prescribed antibiotics to prevent infections. If you experience severe pain, you can ask your doctor for prescription medicine for pain. Avoid getting pregnant for 3 to 6 months after the procedure. You can ask your gynecologist or MD family medicine doctor about birth control measures.

When should I call for immediate medical care?

If you have a myomectomy, contact your surgeon or emergency care facility if you experience any of the following symptoms:

Severe pain that is not relieved by over-the-counter medicine
Heavy vaginal bleeding
Abnormal vaginal discharge
Fever, chills, and other flu-like symptoms
Difficulty breathing
Chest pain
Redness and swelling in the legs
Cramps in the legs

Frequently Asked Questions about Myomectomy: What to Expect

What to expect immediately after fibroid surgery?

Most women experience mild to moderate pain at the site of incisions for the first few days after the procedure. You can use pain medicine to obtain relief.

Your surgeon will also encourage you to take short walks and move your legs after surgery to prevent the formation of blood clots in the legs. This can protect you against a serious complication affecting the leg called a deep vein thrombosis. Walking boosts blood flow and reduces the chances of clot formation. Your doctor might prescribe blood thinner to prevent blood clot formation.

You may also experience light vaginal bleeding, passing bright red blood clots, and mild pelvic pressure for a few days after the procedure. You might be required to wear sanitary pads for a few days. You will also be asked to wear loose clothes and use pain medicines to manage pelvic pain and pressure.

Women who undergo myomectomy have improved pregnancy outcomes within 10 to 12 months after the surgery.

How painful is myomectomy surgery?

Myomectomy may cause mild to moderate pain and discomfort. Over-the-counter pain medicine is often adequate for managing these side effects.

Can fibroids come back after myomectomy?

Yes, it is possible to have a recurrence of uterine fibroids after a myomectomy. Younger women below the age of 40 years having multiple or large fibroids are at higher risk of the recurrence of fibroids after a myomectomy. You can call your doctor to know about follow-up care needed to monitor the growth of new fibroids.

Women in the perimenopausal age have a significantly lower risk of having recurring fibroids.

Can I have a baby after a myomectomy?

Yes, you can get pregnant and have a baby after a myomectomy. You can discuss your desire for pregnancy with your doctor before the procedure.

However, this procedure can increase the need for a C-section in future pregnancies due to the potential complications associated with normal vaginal delivery.

Can I take prescription pain medicine?

Yes, you can call your doctor to know prescription pain medicines you can use to get relief from pain and discomfort at the site of surgery.

What will my periods be like after the myomectomy?

Most women experience lighter and more regular periods after the surgical removal of uterine fibroids.

Will my body change after a myomectomy?

No. Other than finding relief from the symptoms of fibroids, there is usually no noticeable change in the body shape or appearance of women after myomectomy. Your uterus and other reproductive organs will still function normally after this procedure. Hence, you will resume your periods shortly after a myomectomy.

Contrary to what most people believe, women do not enter premature menopause after this procedure. Ask your doctor if you have any questions before your surgery.

Will I have a scar from a myomectomy?

Yes, a laparoscopic or abdominal myomectomy leaves one or more scars on the abdomen. However, most scars fade over time. Also, taking your prescription medicine, including antibiotics, will allow the surgical site to heal properly and reduce scarring.

An abdominal myomectomy leaves a scar below the underwear line. The scars from laparoscopic procedures are usually smaller and closer to the belly button. They would be noticeable only when you wear a short shirt or a two-piece bathing suit.

Hysteroscopic myomectomy does not leave any scar as the procedure is performed through the vagina.

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