All you need to know about myomectomy, straight from a specialist

Myomectomy is a surgical procedure designed to remove uterine fibroids, which are benign growths that can cause a variety of symptoms and complications.

Here, Mr Glefy Furtado, renowned consultant obstetrician, gynaecologist and urogynaecologist, provides an expert insight into the procedure, its benefits, and what to expect before, during, and after surgery.

What are the indications for a myomectomy?

A myomectomy is typically indicated for women experiencing significant symptoms due to uterine fibroids, such as:

• heavy menstrual bleeding
• pelvic pain and pressure, caused by the size and location of the fibroids
• bladder and bowel problems, such as frequent urination or constipation
• infertility
• recurrent miscarriages

How should I prepare for a myomectomy?

You will have a consultation with a specialist such as a gynaecologist to discuss your symptoms, medical history, and treatment options. This will be followed by a physical examination, which includes a pelvic exam to evaluate the size and location of the fibroids.

Several tests will also be conducted. Blood tests, for example, will be performed to check for anaemia and other conditions that might affect the surgery. Imaging studies, such as ultrasound or MRI scans, will provide detailed information about the fibroids. In some cases, an endometrial biopsy may be taken to sample the uterine lining and rule out other conditions.

Your gynaecologist may recommend stopping certain medications, such as blood thinners, before surgery. Typically, you will be required to abstain from eating or drinking for a specified period before the procedure. Additionally, avoiding smoking and limiting alcohol intake can help reduce surgical risks and promote healing.

Lastly, it’s important to arrange for someone to drive you home and assist with daily activities during the initial recovery period. Plan for adequate time off from work as well.

How is a myomectomy performed?

The main objective of a myomectomy is to remove the fibroids while preserving the uterus, which is particularly important for women who wish to preserve their fertility. There are several types of myomectomy procedures, each tailored to the location, size, and number of fibroids, as well as the patient's overall health and reproductive plans.

During surgery, general anaesthesia will be administered to ensure you are asleep and pain-free during the procedure. Depending on the type of myomectomy, the surgeon will make the necessary incisions and remove the fibroids:

• Abdominal myomectomy: Open surgery. The surgeon makes a large horizontal or vertical incision in the lower abdomen to access the uterus and remove the fibroids.
• Laparoscopic myomectomy: Minimally invasive surgery. The surgeon makes small incisions, and then uses a laparoscope (a thin, lighted tube with a camera at the end) along with specialised instruments to remove the fibroids.
• Hysteroscopic myomectomy: No incisions are needed. The surgeon inserts a hysteroscope (a thin, lighted tube with a camera at the end) through the vagina and then uses a resectoscope (a long, thin tube with a light source and a camera) to remove the fibroids. This approach is typically used to address fibroids that extend into the uterine cavity, known as submucosal fibroids.

What is recovery like after a myomectomy?

The length of the hospital stay will vary depending on the type of myomectomy performed: an abdominal myomectomy may require a hospital stay of 2 to 4 days, while laparoscopic and hysteroscopic myomectomies are often performed as outpatient procedures or with a short hospital stay. Pain and discomfort are typically managed with medications, and your gynaecologist will prescribe painkillers along with detailed instructions on their use.

Rest is crucial in the initial days after surgery, and activity levels should be gradually increased based on your gynaecologist’s advice. It’s important to keep incisions clean and dry, following specific instructions on bathing and wound care. Additionally, it’s important to attend all scheduled follow-up appointments to monitor the healing progress and address any concerns that may arise.

Full recovery times will vary depending on the type of myomectomy performed. An abdominal myomectomy may require 4 to 6 weeks for complete recovery, whereas laparoscopic myomectomy typically necessitates 2 to 4 weeks, and hysteroscopic myomectomy generally involves recovery within a few days to 2 weeks. Moreover, it’s important to avoid heavy lifting and strenuous activities until cleared by your gynaecologist, gradually resuming normal activities and work as advised.

Will having a myomectomy impact my fertility?

Myomectomy often has a positive impact on fertility for many women if the fibroids were causing infertility or recurrent miscarriages. Your gynaecologist will provide guidance on the optimal timing for attempting conception, typically advising to wait a few months to allow the uterus to heal properly before trying to conceive again. This cautious approach helps ensure the best possible outcomes for both mother and baby.

Pregnancy following myomectomy often necessitates closer monitoring, particularly if there was extensive repair of the uterine wall during surgery. Depending on the size and location of the fibroids removed, your gynaecologist may recommend a caesarean as the delivery method to mitigate the risk of uterine rupture during labour. This approach will ensure the safety of both the mother and the baby during childbirth.

Above all, women should know that while myomectomy removes existing fibroids, new fibroids can also develop. Regular follow-up and monitoring are important.

To schedule an appointment with Mr Glefy Furtado, head on over to his Top Doctors profile today.