Uterine Fibroid Surgical Treatment
Uterine fibroids occur in an estimated 20 to 80 percent of women. They are most common in women from their 30s to their early 50s. Most women will have small fibroids and no symptoms. If you have large fibroids, they can be painful and may affect your ability to get pregnant.
Our OB/GYN physicians who specialize in infertility at the Utah Center for Reproductive Medicine (UCRM) can diagnose uterine fibroids and help you determine whether you need surgery, such as a myomectomy, to remove them.
What Is a Myomectomy?
Myomectomy is a surgical procedure to remove fibroids when medications and other non-surgical treatments do not improve symptoms of uterine fibroids, including:
- pain,
- heavy bleeding during menstrual periods, and
- infertility.
Types of Myomectomy Procedures
You will be under anesthesia (put to sleep) during the whole procedure and should not feel pain during the procedure, or remember the procedure afterward. A myomectomy is usually an outpatient procedure, which means you will not need to stay overnight at the hospital. However, you will need someone to drive you home after surgery once you wake up.
Hysteroscopic Myomectomy
During hysteroscopic myomectomy, your surgeon will insert a small lighted camera through your vagina, which will be guided up to your uterus. They will push sterile saline (saltwater) into the uterus to expand it so they can examine your inner uterine walls. This fluid can be absorbed into your body much like other fluids. Your surgeon will carefully monitor these fluid levels to minimize any risk of fluid overload in your body.
Your surgeon will use a small tool to cut the fibroid tissues away from your uterus with a blade. Your surgeon will finish the surgery by removing any extra saline fluid in your uterus.
Laparoscopic Myomectomy
Your surgeon will make one or more small incisions (cuts) in your abdomen. They will insert a small tube with a camera to see your uterus. Next, they will insert small tools to cut the fibroid(s) away from your uterus and pull them out through the abdominal incisions. We may consider this procedure to remove fibroids that measure up to 10 centimeters.
Abdominal Myomectomy
If your fibroids are too large to be removed with a hysteroscopy or laparoscopy, we will perform an abdominal myomectomy. Your surgeon will start by making one large incision (cut) along your abdomen. Most surgeons will try to use a horizontal incision along your bikini line (the lower part of your stomach) so the scar will be less noticeable.
Sometimes the surgeon will have to make a vertical incision from below the belly button down toward pubic bone. If you have an existing scar from a previous surgery, they may be able to use the same incision to avoid making another scar. They will remove the fibroid(s) with a small blade and pull them out through the incision.
Abdominal myomectomies sometimes require a one to two-day stay in the hospital for recovery.
Find a Uterine Fibroid Specialist
Myomectomy Recovery Tips
After your myomectomy, you may have some mild cramping. Most patients with hysteroscopic myomectomy do not have a lot of pain and do not need prescription pain medication. You can take over-the-counter pain medication (such as acetaminophen) to manage pain after surgery. Your surgeon will talk with you about stronger pain medications if necessary.
Best Way to Sleep after Myomectomy
After your laparoscopic or abdominal myomectomy, you may have pain around your incision sites as they heal. Until your incisions heal, avoid sleeping on your sides or stomach for a few days to a few weeks after these procedures.
Sex After Myomectomy
Do not have sex for at least two weeks after myomectomy surgery. Some people may need to wait longer, depending on the type of myomectomy surgery they had. Ask your surgeon how long you’ll need to wait to have sex.
Menstrual Period after Myomectomy
Most people will have normal periods after their myomectomy surgery. It’s common to have some slight bleeding or spotting for one to two days after your fibroids are removed, but this is usually not a menstrual period.
Patients who stop taking their hormonal birth control or other medications that contain progesterone right before surgery will usually have a period within three to four days after the myomectomy surgery. This is different from bleeding or spotting after surgery and is normal bleeding from stopping the hormones.
Heavy menstrual bleeding is often a symptom of uterine fibroids. If you had heavy menstrual bleeding before, you can expect to have a more normal menstrual cycle after your myomectomy surgery.
Myomectomy Complications
Myomectomy surgery is generally very safe, especially a hysteroscopic myomectomy where there are no incisions (cuts). However, there are still some risks with this procedure. Call your doctor or go to an emergency room if you have:
- redness around the incision site that is spreading,
- fever or chills,
- discharge or pus coming from an incision,
- an incision that will not close,
- a closed incision that opens again,
- severe pain at the incision site,
- severe pain or cramping in your abdomen,
- tenderness when you touch your abdomen,
- green or yellow vaginal discharge, or
- heavy vaginal bleeding (soaking through more than two pads in one hour).
Pregnancy after Myomectomy
We may recommend waiting up to three months before trying to get pregnant to allow your uterus to heal after a myomectomy. Your doctor will also talk to you about some parts of pregnancy that could be affected by myomectomy surgery.
You may need to have a planned C-section instead of a vaginal delivery, since the fibroid and its surgical removal disrupts your uterine muscle thickness. This could put you at risk for a ruptured uterus or other complications during pregnancy and labor. Tell your OB/GYN about your myomectomy surgery so they can monitor your pregnancy and create a plan for your delivery.
If you are experiencing infertility because of uterine fibroids, fibroid removal can improve your chance of getting pregnant. However, a myomectomy does not guarantee that you will be able to get pregnant.
There may be other factors that are contributing to infertility, such as advanced maternal age, tubal blockage, low ovarian reserve, or poor egg quality. If you are still having trouble getting pregnant after a myomectomy, talk to one of our fertility specialists.
Myomectomy vs. Hysterectomy
Myomectomy and hysterectomy are two different ways to treat uterine fibroids. Myomectomy is called a fertility-sparing surgery because it leaves your reproductive organs (e.g., your uterus, fallopian tubes, and ovaries) intact so you can try to get pregnant in the future.
Hysterectomy is a surgery that removes your whole uterus. After a hysterectomy, you will not be able to get pregnant. Some women with severe or very large fibroids may need a hysterectomy if other treatment options do not relieve their symptoms. In rare cases, a surgeon will recommend a hysterectomy to stop bleeding after fibroid surgery, even without large fibroids. Our OB/GYNs will help you understand all your options to choose the one that is right for you.
Schedule an Appointment
Schedule an appointment with a fertility specialist at the Utah Center for Reproductive Medicine to discuss your uterine fibroids and learn about our surgical and non-surgical treatment options. Call 801-581-3834 or request an appointment online.
Most women can also schedule an appointment to see our gynecologists without a referral from their primary care provider. However, some insurance plans may require that you get a referral. Talk to your insurance carrier with any questions about your coverage.
