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Myomectomy

A myomectomy is a surgical procedure to remove uterine fibroids.

Uterine fibroids (also known as uterine myomas or leiomyomas) are non-cancerous growths formed of muscle and fibrous tissue that grow in and around the uterus. They are very common and often don’t cause any symptoms.

Contact Gynaecology Clinic

Uterine fibroids (also known as uterine myomas or leiomyomas) are non-cancerous growths formed of muscle and fibrous tissue that grow in and around the uterus. They are very common and often don’t cause any symptoms. However when they do, these include:

  • Painful or heavy periods
  • Abdominal pain
  • Lower back pain
  • Frequent urination
  • Pain or discomfort during sex

If a fibroid grows very large, you may also notice swelling in your abdomen.

Fibroids can grow anywhere in the uterus and vary from the size of a pea to the size of a melon.

There are three main types:

  • Intramural – the most common type of fibroid. These develop in the muscle wall of the womb.
  • Subserosal – these develop on the outside of the uterus and can grow to a very large size.
  • Submucosal – these develop in the muscle layer below the inner lining of the uterus and grow into your womb.

In some cases, fibroids are connected to the uterus by a stalk of tissue. These are known as pedunculated fibroids.

The exact cause of fibroids is not known, but they are linked to oestrogen. As such, fibroids can shrink, especially after the menopause when oestrogen levels decrease.

Before

If a fibroid isn’t causing any symptoms, it won’t need to be treated.

However, if you are experiencing symptoms and your quality of life is being affected, book an appointment with one of our experienced gynaecologists. Our gynaecologists aim to provide a one-stop service so you can leave your appointment with a diagnosis and knowing your next steps.

When you come in for your appointment, your gynaecologist will take a detailed medical history and ask you about your symptoms, including when they started, if they have been getting worse and whether they’re new or recurring. They will then conduct a physical examination and run an ultrasound scan, which will confirm your diagnosis.

If you do have a fibroid (or fibroids), the ultrasound scan will show your doctor its location, size and type.

Just because you have fibroids, it doesn’t mean you will need surgery. In the first instance, your gynaecologist will prescribe medications to address your symptoms, such as heavy periods and pain. If these do not provide relief, they may prescribe medications that aim to shrink the fibroid.

If the medicinal approach does not alleviate your symptoms, your gynaecologist will recommend surgery to remove your fibroid(s).

Preparing for surgery

If you decide to go ahead with surgery, we will help you prepare, but you should also try to eat healthily in the run up and stop smoking if you can.

Preparation will involve having some pre-operative tests, including an MRSA test. We will also give you some specific antibacterial soap and lotions to use in the run up to the procedure, which will help reduce your risk of contracting MRSA.

If you take any blood thinners—for example, Warfarin or aspirin, tell your gynaecologist straight away, as you may need to stop taking these or modify your intake from a week before surgery. Your gynaecologist will give you specific instructions if this is the case. You should also tell them if you take nonsteroidal anti-inflammatory drugs, such as ibuprofen.

You cannot eat for 6 hours prior on the day of your surgery. You can drink water up to four hours prior to surgery. You cannot eat chewing gum and hard candies. Brush your teeth with toothpaste only on the morning of surgery. If you take any prescription medications, bring them to hospital with you. Your doctor will let you know if you can take these with a sip of water before your surgery or if you should wait until after.

On surgery day, it’s a good idea to wear loose, comfortable clothing and bring a small bag with things you might need during your stay. Items to remember include a toothbrush and toothpaste, your phone and a charger, a book, any prescription medications and a change of clothes.

Once you have arrived and are settled in your room, a nurse will help prepare you for surgery by monitoring vital signs and running through your medical history, medications and emergency contacts.

Your doctor will then run you through the procedure once again and ask you to sign a consent form for surgery.

During

There are several types of myomectomy, each with its own approach and considerations. The choice of a specific type of myomectomy depends on factors such as the size, number, and location of your fibroids, as well as your overall health and reproductive goals.

The three common types of myomectomy are:

Laparoscopic myomectomy:

A laparoscopic myomectomy is performed if the fibroids are small to moderate in size. This is a minimally-invasive day-case surgery, which means you can be treated and go home after a one or two night hospital stay.

A laparoscopic myomectomy is done under general anaesthetic, so you will be asleep.

To start with, you will have an intravenous (IV) line fitted into a vein, usually in an arm or hand. Through this, your surgical team can quickly give you medications and fluids. The surgical team will also place monitors on you that will help keep you stay safe throughout surgery.

Then, small incisions, typically ranging from 0.5 to 1.2 centimetres, will be made in the abdomen. Trocars (hollow tubes) are inserted through these incisions to provide access for specialised laparoscopic instruments.

The abdomen will then be expanded with carbon dioxide, so your surgeon has the clearest view possible of your uterus. A laparoscope, which is an instrument with a tiny camera and light, will guide the operation. Once located, the fibroids will be removed via the small incisions.

To finish, your abdominal wall will be deflated and the incisions closed with stitches or wound glue, with a protective bandage placed on top.

Patients typically experience less pain, smaller scars, and a quicker recovery compared to open surgery.

Abdominal myomectomy

An abdominal myomectomy is also referred to as an open myomectomy. It may be recommended if you have many fibroids or large fibroids. The procedure involves making a larger incision through your abdomen, providing direct access to the uterus. This is normally horizontal and on the lower abdomen. However, if your uterus is larger, the fibroids are higher up or you have a scar from a previous surgery, your surgeon may make a vertical incision.

Once the fibroid(s) has been removed, the surgeon will close the wound with surgical stitches.

You will need to stay in hospital for one or two nights after this surgery and recovery will take a few weeks.

Hysteroscopic myomectomy

An hysteroscopic myomectomy is ideal for women who suffer with submucosal fibroids or have small fibroids that do not sit deep in the uterine lining. It is the least invasive of the procedures and requires no incisions.

In this procedure, an hysteroscope (a tube with a tiny camera, a light and a tool for removing fibrotic tissue) is inserted into the uterus via the vagina and cervix. The hysteroscope is then used to shave off the submucosal fibroids.

This is a day-patient procedure, so you can be treated and go home the same day. It can be performed under general anaesthetic or sedation.

Medically reviewed by Mr Emeka Okaro - MBBS FRCOG on 17/01/2024

How to pay for your treatment

If you’re… paying for yourself

Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.

For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.

If you’re… insured

St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.