Myomectomy for Uterine Fibroids: What to Expect

Uterine fibroids, also known as leiomyomas, are non-cancerous growths that form in or around the uterus. They can cause a variety of symptoms, including heavy periods, pelvic pain, and even issues with fertility. For women looking to ease these symptoms while keeping their uterus intact, a myomectomy may be the right solution. This surgery is particularly popular among women who want to preserve their ability to have children. Below, we’ll go over what a myomectomy involves, what happens during the procedure, and what the recovery process looks like.

A] What Is a Myomectomy?

A myomectomy is a type of surgery that removes uterine fibroids without taking out the uterus. This is different from a hysterectomy, which removes the uterus entirely. By keeping the uterus, a Myomectomy for Uterine Fibroids allows women to maintain their reproductive health, making it a good option for those who want to have children later.

Types of Myomectomy

Below are the three types of myomectomy:

• Open Myomectomy

This is the traditional method involving a larger incision in the abdomen to access the uterus. It’s typically used when there are multiple fibroid removals or when the fibroids are particularly large.

• Laparoscopic Myomectomy

This minimally invasive method uses tiny incisions and a small camera, called a laparoscope, to guide the surgeon. It’s often used for smaller fibroids and has a shorter recovery time compared to the open method.

• Hysteroscopic Myomectomy

This approach involves inserting a thin scope through the vagina and cervix to reach fibroids inside the uterine cavity. It’s ideal for submucosal fibroids, which grow inside the uterus.

Your doctor will recommend the best option based on the size, location, and number of fibroids.

B] What to Expect During the Procedure

If you’re preparing for a treatment for fibroids, it’s helpful to know what to expect before, during, and after the uterine fibroid surgery.

Before Surgery

• Medical Testing

Your doctor will likely perform an ultrasound or MRI to get a clear picture of the fibroids’ size, number, and location. Blood tests may also be done to check for anaemia or other health conditions.

• Medications

In some cases, you might be prescribed medications to shrink the fibroids before surgery, which can make the procedure easier and less invasive.

• Pre-Surgery Instructions

You may need to fast for 8-12 hours before the procedure. If you’re taking medications like blood thinners, your private gynaecologist in London or where you live may ask you to stop them temporarily in the days leading up to surgery.

During Surgery

• Anaesthesia

Most myomectomies are done under general anaesthesia, though some may use spinal anaesthesia.

• Surgical Process

The surgeon will remove the fibroids and, if needed, repair the uterus. The exact technique depends on the type of myomectomy being performed.

• How Long It Takes

The procedure can take anywhere from 1 to 4 hours, depending on the complexity.

After Surgery

• Recovery Room

After the surgery, you’ll be monitored to make sure your vital signs are stable. Pain or mild cramping is normal and can usually be managed with medication. You might also experience some light spotting or nausea.

C] Recovery Process

Recovery from a fibroid removal surgery varies depending on the surgical approach used and individual factors. Below is a more detailed outline of what to expect during the recovery period.

Hospital Stay

• After an open myomectomy, you may need to stay in the hospital for anywhere between 1 to 3 days. This is to ensure proper healing, manage postoperative pain, and monitor for any complications.
• For laparoscopic or hysteroscopic procedures, recovery is generally quicker, and you may be discharged on the same day or after an overnight stay, depending on your condition and your healthcare provider’s advice.

Home Recovery

• Rest

A full recovery can take 4 to 6 weeks for an open myomectomy and about 2 to 4 weeks for laparoscopic or hysteroscopic procedures. During this period, it’s important to get plenty of rest. While some activity is encouraged to improve circulation and reduce complications, it’s essential to avoid strenuous activities, heavy lifting, and intense exercise during this initial recovery period.

• Pain Management

Postoperative pain is common after any myomectomy. Your doctor may prescribe painkillers or recommend over-the-counter medications to alleviate discomfort. Pain usually lessens after the first few days, but you may continue to experience some mild discomfort or soreness for several weeks.

• Diet and Hydration

Maintaining a balanced diet and drinking plenty of fluids is crucial for recovery. This will help support your body’s healing process and also prevent constipation, a common issue after surgery due to medication or decreased physical activity. A high-fiber diet can aid in preventing this.

• Follow-Up Appointments

Regular follow-up appointments will be scheduled with your healthcare provider. These are important to monitor your healing process and to ensure there are no complications. Your doctor will also track any signs of fibroid recurrence and assess the success of the procedure.

Emotional and Physical Adjustments

Recovery is not only a physical process but an emotional one too. Some women may experience emotional shifts due to hormonal changes or concerns about their future fertility. It’s important to be aware of these potential changes and seek support if needed. Consider reaching out to a counsellor, therapist, or joining a support group to help you through the emotional aspects of recovery.

Tips for a Smooth Recovery:

• Wear loose, comfortable clothing to avoid irritation around the surgical site, particularly in the first few weeks after surgery.
• Take short, gentle walks as soon as your doctor gives the go-ahead. This helps improve circulation, which reduces the risk of blood clots and aids in your overall recovery.
• Follow the instructions provided by your healthcare provider to keep the incision area clean and dry, preventing infection or irritation.

D] Risks and Considerations

While myomectomy is generally safe, it’s important to be aware of potential risks and considerations associated with the procedure.

Possible Recurrence of Fibroids:

• Fibroids can grow back after surgery, especially in women who are not yet menopausal. Discuss recurrence risks with your doctor to plan appropriate follow-up care.

Fertility Concerns 

• Scarring 

1. 1. • The formation of scar tissue (adhesions) can occur, which may affect the uterus or fallopian tubes, potentially impacting fertility.

• Pregnancy After Myomectomy 

1. • Women are typically advised to wait 3 to 6 months before trying to conceive to allow the uterus to heal fully. You can consult an expert if you want to understand the occurrence of uterine fibroids during pregnancy.

Surgical Risks

• As with any surgery, there is a small risk of infection, excessive bleeding, or complications related to anaesthesia.
• Rarely, a hysterectomy may become necessary if there are complications during the procedure.

Alternatives to Myomectomy

For women who are not planning future pregnancies, other treatment options may be considered, such as:

• Uterine Fibroid Embolisation (UFE): A minimally invasive procedure to shrink fibroids by cutting off their blood supply.

• Medications: Hormonal therapies or GnRH agonists to manage symptoms without surgery.
• Focused Ultrasound: Non-invasive treatment using high-intensity ultrasound waves to destroy fibroids.

Conclusion

A myomectomy is an effective and fertility-preserving treatment option for women suffering from uterine fibroids. Understanding the different types of myomectomy, what to expect during and after the procedure, and the associated risks can help you make an informed decision. Proper preparation, adherence to recovery guidelines, and regular follow-ups with your healthcare provider are essential to achieving the best outcomes.

Whether you’re considering myomectomy to alleviate symptoms or to pursue your dreams of motherhood, this procedure can provide a pathway to improved health and well-being. Schedule a consultation with a healthcare provider today to discuss your options and address any concerns.