Patient education: Myomectomy (The Basics)

What is a myomectomy? — 

This is surgery to remove 1 or more fibroids. Fibroids are abnormal growths that form in the muscle of the uterus (figure 1).

A myomectomy can be done in 3 ways, depending on where the fibroids are:

●Open surgery – The doctor makes a cut, or "incision," in the belly to remove the fibroids.

●Minimally invasive surgery – The doctor makes smaller incisions in the belly. They insert long, thin tools through the incisions. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the belly. Then, they use the long tools to do the surgery. They can control the tools directly, or with the help of a robot (called "robot-assisted" surgery).

●Vaginal or "hysteroscopic" surgery – The doctor uses a camera or other tools to remove the fibroids. No incisions are needed.

Sometimes, doctors need to switch to open surgery after a minimally invasive surgery has been started.

You might be able to return to normal activities sooner if you had minimally invasive or vaginal surgery.

How do I prepare for a myomectomy? — 

The doctor or nurse will tell you if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam. They might order tests, such as:

●Lab tests

●Ultrasound or other imaging tests

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – You might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection –You might need to wash the area with a special soap.

●What you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

What happens during a myomectomy? — 

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This type blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. You might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type makes you unconscious so you can't feel, see, or hear anything during the procedure. You might get a breathing tube to help you breathe.

•IV sedation – This means getting medicines through your IV to make you relax and feel sleepy.

●You might get medicines to help control pain after the procedure.

●The doctor will put a thin, flexible tube called a "catheter" into your bladder. This is to drain urine during the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will use special tools to remove the fibroids from your uterus.

●They will close your incisions (if you have them), and cover them with clean bandages.

What happens after a myomectomy? — 

You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. You might be able to go home the same day, or you might have to stay in the hospital for a few days.

As you recover:

●You might feel groggy or confused for a short time. The doctor or nurse can give you medicine to help with this.

●If you had a catheter in your bladder, it will be removed.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of myomectomy? — 

Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Bleeding

●Infection

●The wound opening up

●Scar tissue forming in your uterus

●Blood clots in your legs or lungs

●Injury to nearby organs

●Fluid overload, if you had hysteroscopic surgery

Sometimes during a myomectomy, the doctor will need to remove the entire uterus. This is called "hysterectomy." It is not common to need an unplanned hysterectomy, but it can happen. After a hysterectomy, it is not possible to get pregnant.

What else should I know? — 

If you want to try to get pregnant, doctors usually recommend waiting at least 3 to 6 months after myomectomy.

If you do get pregnant in the future, your doctor might recommend a cesarean birth. This is because having a myomectomy can increase the risk of a tear in the uterus during pregnancy or labor. Whether to have a cesarean birth depends on several different things. Your doctor will talk to you about your options and help you decide.

More on this topic

Patient education: Myomectomy – Discharge instructions (The Basics)
Patient education: Uterine fibroids (The Basics)
Patient education: Hysterectomy (The Basics)
Patient education: Cesarean birth (The Basics)

Patient education: Uterine fibroids (Beyond the Basics)
Patient education: Vaginal hysterectomy (Beyond the Basics)
Patient education: C-section (cesarean birth) (Beyond the Basics)