What to Expect from Fibroid Surgery

There are two types of fibroid procedures. Which one you have depends on:

• the size of your fibroids
• the number of fibroids you have
• where in your uterus they’re located
• whether you want to have children

Myomectomy

Myomectomy removes your fibroids and can relieve bleeding and other symptoms. This surgery is an option if you’d like to have children in the future, or if you want to keep your uterus for another reason.

About 80 to 90 percent of women who have a myomectomy get relief from their symptoms or see their symptoms reduced. The fibroids won’t grow back after surgery, but you may develop new fibroids. Up to 33 percent of women who have this surgery will need a repeat procedure within 5 years because they grow new fibroids.

This surgery can be done in one of three ways, depending on the number, size, and location of your fibroids. You’ll be under general anesthesia for all of these procedures.

Hysteroscopy

This procedure is more effective for women with smaller and fewer fibroids. Hysteroscopy can also remove fibroids that have grown into the inside of your uterus.

During the procedure, the doctor inserts a long, thin, lighted telescope through your vagina and cervix into your uterus. Fluid is injected into your uterus to expand it and help your doctor see your fibroids.

Then, the surgeon uses a device to cut or destroy your fibroids. The fibroid pieces wash out with the fluid that was used to fill your uterus.

With hysteroscopy you may go home the same day as your surgery.

Abdominal myomectomy

This procedure, also known as a laparotomy, is better for large fibroids, but it leaves a bigger scar than the other two types of myomectomy. For this procedure, your surgeon makes a cut in your lower belly and removes your fibroids.

After abdominal myomectomy, you’ll stay in the hospital for one to three days. Complete recovery takes 2 to 6 weeks.

Laparoscopy

Laparoscopy is used for women who have smaller and fewer fibroids. During laparoscopy, your surgeon makes two small cuts in your belly. A telescope is inserted into one of the openings to help your doctor see inside your pelvis and around your uterus. A tool is inserted into the other opening to remove your fibroids.

Your surgeon may cut your fibroids into small pieces before removing them. In robotic laparoscopy, your surgeon uses robotic arms to perform the procedure.

Laparoscopic procedures may require an overnight hospital stay but have a faster recovery than abdominal myomectomy.

Hysterectomy

Hysterectomy removes part or all of your uterus. This procedure may be an option if you have a lot of fibroids, they’re large, and you’re not planning to have children.

The surgeon can remove your uterus in a few different ways:

• Laparotomy or abdominal hysterectomy. Your surgeon makes a cut in the lower abdomen and removes your uterus.
• Vaginal hysterectomy. The surgeon removes your uterus through your vagina. This approach may not work for very large fibroids.
• Laparoscopic hysterectomy. The surgeon inserts the instruments and removes the uterus through small incisions. This procedure can be done robotically.

The surgeon may leave your ovaries and cervix in place. Then you will continue to produce female hormones.

Complete recovery from an abdominal hysterectomy takes 6 to 8 weeks. Recovery from laparoscopic and vaginal hysterectomy is quicker.

Hysterectomy is the only surgery that cures uterine fibroids and fully relieves their symptoms. However, you will no longer be able to have children.

Endometrial ablation isn’t surgery, but this procedure is still minimally invasive. It destroys the lining of your uterus. It works best in women who have small fibroids located close to the inside of the uterus.

Ablation doesn’t remove your fibroids, but it does help relieve heavy bleeding. It’s also not for women who want to get pregnant in the future.

Endometrial ablation can be done in your doctor’s office or a hospital. Sometimes it’s performed at the same time as other procedures.

You may get general anesthesia during the procedure. Or, you may get spinal or epidural anesthesia to numb you from the waist down.

During the procedure, the doctor will insert a special instrument into your uterus and burn off your uterine lining using one of these methods:

• an electric current
• a balloon filled with heated fluid
• high-energy radio waves (radio frequency)
• a cold probe
• microwave energy
• heated fluid

You can go home on the same day as your procedure. Your recovery time will depend on the type of ablation you had.

Endometrial ablation is effective for relieving heavy bleeding from fibroids.

Fibroid surgery and endometrial ablation can help relieve symptoms like heavy bleeding and abdominal pain. Removing your uterus provides a permanent solution to most fibroid-related symptoms.

All of these procedures are safe, but they can have risks, such as:

• bleeding
• infection
• the need for a repeat procedure
• damage to organs in your abdomen, such as your bladder or bowel
• scar tissue in your abdomen, which can form bands that bind organs and tissue together
• bowel or urinary problems
• fertility issues
• pregnancy complications
• rare chance that you’ll need a hysterectomy

Laparoscopy causes less bleeding and other complications than laparotomy.

How fibroid surgery affects your fertility depends on which type of procedure you have. You will not be able to carry a child after hysterectomy since your uterus will be removed. You should be able to conceive after myomectomy.

After an ablation, you likely won’t be able to get pregnant, but you should use contraception following the procedure. This is because the procedure removes the endometrial lining where the egg would normally implant. If you do conceive, you’ll be at higher risk of having a miscarriage as well other serious pregnancy complications.

If you have a procedure that allows you to get pregnant in the future, you may need to wait three months or more before trying to conceive to be sure your uterus has fully healed.

Surgery isn’t the only way to treat fibroids. Certain medications can be used to help reduce the symptoms that go along with fibroids, but these options will not eliminate your fibroids. Other options include:

Medications

• Nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) can help relieve pain.
• Birth control pills and other types of hormonal birth control methods such as progestin-releasing IUDs can help with heavy bleeding.
• Anti-hormonal drugs like progestin or danazol block estrogen to treat fibroids.
• Gonadotropin-releasing hormone agonists (Lupron, Synarel) block the production of estrogen and progesterone, and put you into temporary menopause, which shrinks your fibroids. Your doctor might prescribe these to make your fibroids smaller before surgery.
• Tranexamic acid (Lysteda) reduces heavy bleeding during your periods.

Noninvasive procedures

• MRI-guided focused ultrasound surgery uses sound waves guided by an MRI scanner to heat and destroy your fibroids through your skin.
• Uterine artery embolization injects tiny particles into the arteries that supply your uterus. Cutting off blood flow to the fibroids causes them to shrink.
• Myolysis, such as the Acessa procedure, uses an electric current or heat to destroy your fibroids and the blood vessels that supply them.
• Cryomyolysis is similar to myolysis, except that it freezes the fibroids.

Surgery can often relieve pain, heavy bleeding, and other uncomfortable symptoms of uterine fibroids. These procedures can have side effects. And if you have a hysterectomy, you’ll no longer be able to have children.

Talk with your doctor about all of your treatment options. Learn the benefits and risks of each one before making your decision.