Myomectomy is a surgical procedure to remove uterine fibroids. These are common noncancerous growths that appear in the uterus, usually during childbearing age, but they can occur at any age too. The surgeon’s goal during myomectomy is to take out symptom-causing fibroids and reconstruct the uterus. Unlike hysterectomy, which removes the entire uterus, myomectomy removes only the fibroids and leaves the uterus intact. Women who undergo myomectomy report improvement in fibroid symptoms, including heavy menstrual bleeding and pelvic pressure.
If surgery is needed, reasons to choose a myomectomy instead of a hysterectomy for uterine fibroids include: You plan to bear children Your doctor suspects uterine fibroids might be interfering with your fertility You want to keep your uterus
RISKS Risks of myomectomy include: Excessive blood loss. Many women already have low blood counts (anemia) due to heavy menstrual bleeding, so they’re at a higher risk of problems due to blood loss. Your doctor may suggest ways to build up your blood count before surgery. Scar tissue. Incisions into the uterus to remove fibroids can lead to adhesions — bands of scar tissue that may develop after surgery. Outside the uterus, adhesions could entangle nearby structures and lead to a blocked fallopian tube or a trapped loop of intestine. Rarely, adhesions may form within the uterus and lead to light menstrual periods and difficulties with fertility (Asherman’s syndrome). Laparoscopic myomectomy may result in fewer adhesions than abdominal myomectomy (laparotomy). Childbirth complications. A myomectomy can increase certain risks during delivery if you become pregnant. If your surgeon had to make a deep incision in your uterine wall, the doctor who manages your subsequent pregnancy may recommend cesarean delivery (C-section) to avoid rupture of the uterus during labor, a very rare complication of pregnancy. Rare chance of hysterectomy. Rarely, the surgeon must remove the uterus if bleeding is uncontrollable or other abnormalities are found in addition to fibroids.
STRATEGIES TO PREVENT POSSIBLE SURGICAL COMPLICATIONS To minimize risks of myomectomy surgery, your doctor may recommend: Iron supplements. If you have iron deficiency anemia from heavy menstrual periods, your doctor might recommend iron supplements to allow you to build up your blood count before surgery. Hormonal treatment. Another strategy to correct anemia is hormonal treatment before surgery. Your doctor may prescribe a gonadotropin-releasing hormone (Gn-RH) agonist, birth control pills, or other hormonal medication to stop or decrease your menstrual flow. Therapy to shrink fibroids. Some hormonal therapies, such as Gn-RH agonist therapy, can also shrink your fibroids and uterus enough to allow your surgeon to use a minimally invasive surgical approach — such as a smaller, horizontal incision rather than a vertical incision, or a laparoscopic procedure instead of an open procedure. Treatment generally occurs over several months before surgery.
RESULTS Outcomes from myomectomy may include: Symptom relief. After myomectomy surgery, most women experience relief of bothersome signs and symptoms, such as excessive menstrual bleeding and pelvic pain and pressure. Fertility improvement. Removing submucosal fibroids by hysteroscopic myomectomy can improve fertility and pregnancy outcomes. Many factors can impact fertility, but often, women who plan a pregnancy after myomectomy conceive within one year of having the surgery. After a myomectomy, wait three months before attempting conception to allow the uterus enough healing time. Although more studies are needed, the effect of abdominal, laparoscopic or robotic myomectomy on fertility appears to be about the same — more limited than if your fibroids can be removed by hysteroscopic myomectomy. Tiny tumors (seedlings) that your doctor doesn’t detect during surgery could eventually grow and cause symptoms. New fibroids, which may or may not require treatment, also can develop. Women who had only one fibroid have a lower risk of needing to have treatment for additional fibroids — often termed the recurrencerate — than do women with multiple fibroids.
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