Dr Chua Weilyn Natalie
Obstetrician & Gynaecologist
If uterine fibroids are causing you distress and you want to get pregnant in the future, talk to your doctor about the possibility of having a myomectomy.
A myomectomy is a procedure to remove uterine fibroids. If you have been diagnosed with uterine fibroids and are experiencing symptoms including pelvic pain, irregular bleeding, heavy periods or pressure symptoms, and the need to urinate frequently, your doctor may recommend a myomectomy.
Having a myomectomy will allow your doctor to remove your fibroids while preserving your uterus. Doing so will allow you to retain your ability to get pregnant in the future.
There are 3 main types of myomectomy and your doctor will discuss with you the most suitable of the following types of myomectomy for your condition:
This procedure will see your surgeon make a surgical cut to your lower abdomen to get to the fibroids and remove them. Your surgeon may recommend this procedure if you have large fibroids. Full recovery can take up to 4 – 6 weeks.
This procedure is less invasive. Your surgeon will operate to remove the fibroids using a laparoscopic arm inserted through several small incisions on the abdomen. Because the incisions are small, your pain after the surgery will be less than an abdominal myomectomy. This option may be suitable if you have fewer and smaller fibroids. However, this procedure may work for large fibroids too. Full recovery can take between 3 – 4 weeks.
Your surgeon will remove your fibroids through a scope which enters the uterus through your cervix. This surgery may be most suitable if the fibroids are located within the inner lining of the uterus. Recovery takes just a few days.
Like all surgeries, myomectomy brings with it some risks such as infection and bleeding. While the following complications are rare, any concerns should be discussed with your doctor.
Your doctor might recommend iron supplements and vitamins to allow you to build up your blood count before surgery if you have iron deficiency anaemia from heavy menstrual periods.
This strategy may also be useful to correct anaemia before surgery. Your doctor may prescribe a gonadotropin-releasing hormone (GnRH) agonist, birth control pills or other hormonal medication to stop or decrease your menstrual flow.
The use of hormonal therapies, such as GnRH agonist therapy can help to temporarily shrink your fibroids and uterus. This then allows your surgeon to use a minimally invasive surgical approach to remove the fibroids instead of an open surgery. Although GnRH agonist therapy can improve fibroid symptoms, it can also cause unpleasant menopausal symptoms, such as hot flushes, night sweats and vaginal dryness. These symptoms, however, will resolve after the medication is stopped. Talk to your doctor to determine if this is the right option for you.
The likelihood of pregnancy depends on the type and number of fibroids you have.
In women who do get pregnant after a myomectomy, your doctor will likely recommend a caesarean delivery to be scheduled before your estimated due date (EDD) to minimise the risk of a tear of the uterus as the pregnancy progresses or during childbirth.
Most women experience relief from symptoms such as pelvic pain and heavy menstrual bleeding after a myomectomy.
Women who underwent a laparoscopic myomectomy can expect improved fertility and good pregnancy outcomes within a year of surgery.
However, fibroids can also come back after a myomectomy, especially in younger women and those with multiple fibroids. Women with new or recurring fibroids may opt for a hysterectomy (removal of the uterus) as a last resort.
If you have uterine fibroids, consult a gynaecologist and discuss the options available and together you'll be able to make a decision that is most suited for you.