Myomectomy or Removal of Fibroids

Myomectomy is a surgical procedure to remove uterine fibroids. This procedure is performed for women who have bothersome symptoms caused by fibroids such as heavy menstrual flow, irregular uterine bleeding, pelvic and back pain, difficulties falling pregnant, miscarriages, and asymptomatic women who have fibroids larger than 5 cm or grow in size fast.

Myomectomy can be performed in 3 different ways depending on the size and location of fibroids and at times your previous surgical history

  • through laparotomy – an open procedure with a cut that is transverse or in the midline (vertical) depending on the size of the fibroid
  • laparoscopy of key-hole surgery
  • hysteroscopically through the vagina

At times a doctor would recommend performing hysterectomy – removing the uterus (together with fibroids). I recommend hysterectomy for women who suffer from fibroids if they completed the family and do not desire to fall pregnant again. The advantage of doing hysterectomy versus myomectomy is fibroids won’t return, later on, the procedure is associated with less blood loss during surgery and periods will not return. A hysterectomy will also take away the potential risk of uterine or cervical abnormalities or cancer later in life. I usually keep the ovaries and remove only the uterus to avoid surgical menopause. So women still have normal hormone levels.

Myomectomy has low complication rates. The risks of the procedure are

  • excessive bleeding during the operation and needing a blood transfusion. I do take precautionary steps during surgery to avoid such bleeding (I inject medication around fibroids to cause blood vessels to clamp down and use a special wire around the uterus to stop the blood supply to the fibroids during the procedure)
  • scar tissue – bands of scar tissue may develop after the surgery between the uterus and bowel. I use special powder or special material at the end of surgery to prevent adhesions
  • pregnancy and childbirth complications – myomectomy can increase certain risks during pregnancy. If the cut through the uterus to remove fibroids reaches the uterine cavity or goes deeper you will be advised to have a cesarean section to deliver your baby
  • very rarely the bleeding during myomectomy is so heavy and impossible to control and the surgeon has to remove the uterus to control it (perform hysterectomy)
  • Although fibroids are rarely cancerous (chances are 1 in 400) it is possible to mistake cancerous tumours for fibroid and spread the cancerous cells inside the tummy when removing fibroid. The risk of it increases in women in menopause and fast-growing fibroids

The preparations for surgery are similar to other procedures
Please read our document preparing for surgery.
Please read about laparoscopy here and hysteroscopy here.

You should not eat or drink for 6 hours before the procedure. You will be given antibiotics to prevent infection in the theatre. The procedure is performed under general anaesthesia. You may be given medication to prevent clots in your legs and lungs after the surgery. After a hysteroscopy, you will go home the same day. After laparoscopy, you will stay overnight and after laparotomy (open surgery) you will be staying in the hospital for 2 nights. You will have pain medications and compressions stocking on your legs while you are in the hospital. You can eat your normal diet after the surgery. Some people have nausea and vomiting after anaesthesia and in such cases, we treat with medications. You will be looked after by a highly skilled and caring team of health workers who strive to provide the best care to their patients.