What Is a Myomectomy?
A myomectomy is an operation to remove fibroids without removing the uterus (womb). Fibroids are growths of tissue and muscle cells found inside or outside your uterus. Fibroids are usually noncancerous but can be big, small, one, few, or many.
It's unclear what causes fibroids, but it's very common for women to have them in their 40s and early 50s. About 70% of white women and 80% of Black women in America have uterine fibroids by age 50. Fibroids may not cause any symptoms, but if they do, these could be heavy and painful periods and pain in the pelvis or back. Having fibroids doesn't keep you from getting pregnant, but sometimes they cause a miscarriage, pregnancy complication, or premature birth.
Myomectomy vs. hysterectomy
A hysterectomy removes fibroids while also removing the uterus. Your doctor may recommend this type of uterine fibroid surgery if you don't want to have any or any more children because with a myomectomy, there is the possibility of fibroids coming back. However, if you want to keep your ability to have children or want to preserve your uterus, then you should look into a myomectomy.
A myomectomy can relieve:
- Heavy bleeding during periods
- Bleeding between periods
- Pain and pressure in your pelvis
- Iron-deficiency anemia caused by blood loss from your heavy periods
A myomectomy can also improve fertility if the fibroids are large or inside the uterine wall or under the uterine lining.
Types of Myomectomy
Depending on how many fibroids you have, how big they are, and where they're located, your doctor has three choices for your myomectomy:
Abdominal myomectomy (laparotomy)
This operation is needed if your fibroids are really large (more than 4 inches), you have a lot of them, or they're located deep inside the uterus. You'll get general anesthesia so you won't be awake during the procedure. The surgeon makes a cut in your lower abdomen to remove the fibroids. They'll then sew your uterine muscle back together.
You might need to stay in the hospital for two nights, and recovery can take between 4 and 6 weeks. If you do get pregnant in the future, your doctor might want to schedule a C-section. This lowers the risk of the uterus opening during labor due to your history of myomectomy.
If your fibroids are inside the lining of your uterus, your doctor may be able to remove them with this procedure. They'll use an instrument called a hysteroscope, which is like a telescope that lets your doctor see the fibroids. It's fitted with a wire loop called a resectoscope, an instrument that lets your doctor remove the fibroids with high-frequency electrical current, which cuts them loose.
You may get general anesthesia for this procedure, but you'll probably be able to go home after a few hours of recovery. This is the least invasive type of myomectomy, but not every type of fibroid can be removed this way. It's mostly used to remove smaller fibroids not deep inside the uterus.
Your surgeon makes small cuts in your abdomen that let them use tools to remove the fibroids. They insert a laparoscope (a narrow tube with a video camera) into your stomach so they can see (on a computer monitor) to remove the fibroids through the other cuts they made. This surgery takes longer than the abdominal myomectomy but has fewer risks of bleeding and can be used to remove big or small fibroids.
Robotic-assisted myomectomy is a type of laparoscopic myomectomy in which the surgeon sits at a computer and uses controls to direct surgical instruments attached to robotic arms to remove fibroids that are numerous or deep in the uterine wall.
What to Expect With a Myomectomy
Here's what you can expect with a myomectomy, depending on type:
- Anesthesia: general, with a breathing tube
- Hospitalization: 1-2 days
- Incision size: Horizontal incisions are about 4 inches just above the bikini line; vertical incisions at the midline are longer
- Procedure time: 2-3 hours
- Anesthesia: general or local
- Hospitalization: none (usually outpatient)
- Incision size: none
- Procedure time: 30-60 minutes
- Anesthesia: general
- Hospitalization: none (usually outpatient)
- Incision size: 5-12 millimeters
- Procedure time: 3-4 hours
Depending on which type of surgery you had, your recovery period can be anywhere from 2 days to 6 weeks.
With the abdominal myomectomy, you'll probably be in hospital for 2 days. Your recovery time is 4-6 weeks, so plan to be off from work. During that time, don't lift anything heavy, but do some walking each day to avoid the risk of deep vein thrombosis (blood clots in your legs that can go to your lungs). Vaginal bleeding and discharge is normal for 1-2 weeks after surgery. Avoid sex, inserting a tampon, or heavy exercise until you're fully recovered.
Your recovery time with the laparoscopic myomectomy is 2-3 weeks, so plan to be off work. You can start walking the day after surgery, but wait at least 2 weeks to have sex or insert a tampon. Avoid heavy lifting or strenuous exercise until you are healed.
With the hysteroscopic myomectomy, the recovery time is only 1 or 2 days, so you may not need to take time off from work if you do this just before a weekend. Watch out for light vaginal bleeding or cramping during the first week.
In general, regardless of the type of myomectomy you had:
- Expect some vaginal bleeding and discharge.
- Don't have sex or use a tampon until you are healed.
- Avoid heavy lifting until you are healed.
- Rest as your doctor instructs.
- Use over-the-counter pain relievers if you have abdominal cramps or pelvic pain.
- Call your doctor immediately if you have heavy bleeding, fever, or signs of infection (like redness, raising pain, swelling, or a smelly discharge from your wound).
- Wait 3-6 months before attempting to conceive to give your uterus time to heal.
Risks with myomectomy are rare but could include:
- Loss of blood
- Infection at the surgical site
- Weakened uterine walls, which require that any future pregnancies be delivered by C-section
- Damage to nearby body parts, like the bladder
- Blood clots
- Development of scar tissue in the affected area, which may cause infertility
- Development of new fibroids
- Allergic reaction to anesthesia
Body changes after myomectomy
You shouldn't have any body changes after this procedure as you still have your uterus. You won't enter menopause, and your period should start again after you're recovered. You should experience relief from heavy bleeding during your periods.
Other Types of Fibroid Surgery
You don't need to treat your fibroids if they're small and not causing you any discomfort. And if you need to treat them, there are other options beside a myomectomy. Some of them are less-invasive procedures with shorter recovery times and less expensive than a myomectomy. But they have their own risks as well.
Here, your doctor destroys the smooth muscle comprising the fibroid so it shrinks and dies through freezing, heating, or radiofrequency energy. It takes about an hour, and you can go home the same day.
It's best for small fibroids. There's a chance that it can cause scarring or infection in the uterus, which could affect your fertility or cause pregnancy complications. So if you want to get pregnant at some point, tell your doctor so you can weigh the risks and benefits.
Uterine artery embolization (UAE)
This procedure shrinks fibroids rather than cutting them out. Although it's sometimes called uterine fibroid embolization (UFE), the terms are not exactly interchangeable. UFE is a type of UAE to treat fibroids. UAE can treat fibroids and other conditions that cause bleeding in the vagina. But most people have UAE for fibroids. It's best for people with small fibroids.
The doctor inserts a thin tube, called a catheter, into your uterine artery, the main vessel supplying blood to your uterus. Then they inject tiny particles that cut off the blood supply to the fibroids. This technique will shrink or kill them off and allow your uterus to reduce in overall size.
You might need a sedative for the procedure, so you're awake but sleepy. You'll probably feel some pressure when your doctor inserts the catheter, but you shouldn't feel pain.
You'll stay overnight at the hospital and be able to go home the next day. You may have cramping after the procedure, so your doctor will give you some medicine to ease any discomfort. Recovery time is 1-2 weeks.
Occasionally, fibroids grow back or new ones develop after UAE. And there are risks, including damage to the blood vessel. You and your doctor should talk about whether this is the right procedure for you, especially if you want to get pregnant in the future.
This outpatient procedure doesn't involve any cuts to the skin or abdomen but is done through your vagina. It can be done many different ways, such as with laser, heated liquid, electric current, freezing, and more.
You should only consider it if you don't want to get pregnant in the future. Depending on the procedure, you could have it right in your doctor's office. Recovery is usually quick (2-4 days), and you might have a lighter period or no periods at all after surgery. You'll need to use contraceptives or have a tubal ligation to prevent pregnancy. Endometrial ablation would cause future pregnancies to end in miscarriage.
This surgery removes your uterus. It may be the best option if your fibroids are large, you have very heavy periods, and you know you don't want children in the future.
The kind of hysterectomy you get depends on the size of your fibroids. If they're small, your doctor might be able to do the surgery through your vagina. But if they're large, they might need to cut open your abdomen.
In other cases, your doctor might be able to use a laparoscope. Some women have their cervix and ovaries removed during a hysterectomy. Others keep their ovaries. If yours have to be removed, you'll go through menopause. Talk about this with your doctor in advance so you know what to expect.
Hysterectomy is a major surgery. Recovery can take up to 6-8 weeks if your surgery is done through a larger incision in your belly.
Fibroid Surgery Cost
Fibroid surgery costs vary widely depending on the procedure and where you have it. One 2020 study put the average cost of a myomectomy in the U.S. at $14,791, while a hysterectomy costed $14,676 and an endometrial ablation costed $6,702. The same study found 76.5% of the women who had undergone surgery for fibroids had a hysterectomy, 14.5% did an endometrial ablation, and 5% did a myomectomy. Another 4% had UFE, which was around the same price as a myomectomy and a hysterectomy.
Surgery costs have only risen since then. Fortunately, most insurance companies cover fibroid surgery, although you may have to pay a portion of the charges as well. If you don't have insurance, call a few places to find out what they charge for the procedure you're interested in. Fibroid surgery can be performed at hospitals and at specialized centers. Many hospitals have a price estimate tool on their websites where you can get a sense of what they charge for different fibroid surgeries, both with and without insurance.
There are several options for fibroid removal surgery, but a myomectomy is one to consider if you'd like to have children in the future, as it preserves your uterus. There are three types of myomectomy: abdominal, hysteroscopic, and laparoscopic, each with their own pros and cons.
Fibroid Surgery FAQs
How fast do fibroids grow back after fibroid surgery?
About 20% of women who've had a myomectomy have fibroids regrow within the first few years after the surgery. Once you reach menopause, your fibroids will naturally shrink as your estrogen drops. With a hysterectomy, fibroids can't regrow because your uterus is gone.
What happens if uterine fibroids go untreated?
Most of the time fibroids are small and don't cause any problems. But if they are large, they may cause problems such as heavy bleeding (which could lead to anemia), pelvic pain, and difficulty conceiving a child.
When is myomectomy not recommended?
If you have many fibroids or they are large, a myomectomy is not recommended, so you might to do another procedure, likely a hysterectomy.
Is myomectomy a major surgery?
It depends on the type. Abdominal myomectomy is major surgery, but hysteroscopic myomectomy and laparoscopic myomectomy are considered minimally invasive surgeries.