What is Myomectomy

Myomectomy is a surgery in which a non-cancerous fibroid (myoma) is removed from the uterus. Myomas are tumors made up of fibrous tissue. They are often called fibroid tumors.

Fibroid tumors can range from the size of a pea to the size of a grapefruit. In a myomectomy, the fibroid tumor is removed without removing the uterus.

Because these tumors are rarely cancerous, this surgery is usually done only if the tumor is growing or causing symptoms such as pain, pressure, bleeding, or pain with intercourse.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Bleeding.
• Infection.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Blood clots in the legs, chest, or brain.
• Scar tissue on other organs and in the pelvis. This may require another surgery to remove the scar tissue.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

General instructions

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Do not drink alcohol the day before the surgery.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes, for 2 weeks before the procedure. If you need help quitting, ask your health care provider.
• Plan to have someone take you home from the hospital or clinic. Also arrange for someone to help you with activities during your recovery.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins. Medicines will be able to flow directly into your body through this IV tube.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• Small monitors will be attached to your body. They will be used to check your heart, blood pressure, and oxygen level.
• A breathing tube will be placed into your lungs during the procedure.
• A thin, flexible tube (catheter) will be inserted into your bladder to collect urine.
• Your surgeon will use one of the following methods to perform the procedure. The method used will depend on the size, shape, location, and number of fibroids.

Hysteroscopic myomectomy

This method may be used when the fibroid tumor is inside the cavity of the uterus. A long, thin tube with a lens (hysteroscope) will be inserted into the uterus through the vagina. A saline solution will be put into the uterus. This will expand the uterus and allow the surgeon to see the fibroids. Tools will be passed through the hysteroscope to remove the fibroid tumor in pieces.

Laparoscopic myomectomy

A few small incisions will be made in the lower abdomen. A thin, lighted tube with a camera (laparoscope) will be inserted through one of the incisions. This will give the surgeon a good view of the area. The fibroid tumor will be removed through the other incisions. The incisions will then be closed with stitches (sutures) or staples.

Abdominal myomectomy

This method is used when the fibroid tumor cannot be removed with a hysteroscope or laparoscope. The surgery will be done through a larger surgical incision in the abdomen. The fibroid tumor will be removed through this incision. The incision will be closed with sutures or staples. Recovery time will be longer if this method is used.

The procedures may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• The IV access tube and catheter will remain on your body for a period of time.
• You may be given medicine for pain or to help you sleep.
• You may be given an antibiotic medicine if needed.
• Do not drive for 24 hours if you were given a sedative.

Summary

• Myomectomy is surgery to remove a noncancerous fibroid (myoma) from the uterus.
• This surgery is usually done only if the tumor is growing or causing symptoms such as pain, pressure, bleeding, or pain during intercourse.
• Follow instructions from your health care provider about eating and drinking before the procedure.
• Recovery time from this procedure depends on the method. The abdominal method will require a longer recovery time.

Myomectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain in your abdomen, especially at the incision areas. You will be given pain medicine to control the pain.
• Tiredness. This is a normal part of the recovery process. Your energy level will return to normal over the coming weeks.
• Vaginal bleeding. This is normal and will stop in the coming weeks.
• Constipation.

Recovery time from this procedure will depend on the type of procedure you had and your general overall health prior to the procedure.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not take aspirin because it can cause bleeding.
• If you were prescribed an antibiotic medicine, use it as told by your health care provider. Do not stop using the antibiotic even if you start to feel better.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Do not drink alcohol while taking prescription pain medicine.

Incision care

• Follow instructions from your health care provider about how to take care of any incisions. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision areas every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Take showers as directed by your health care provider.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not do activities that require a lot of effort until your health care provider says it is okay.
• Do not lift anything that is heavier than 15 lb (6.8 kg) until your health care provider says that it is safe.
• Do not douche, use tampons, or have sexual intercourse until your health care provider approves.
• Walk daily but take frequent rest breaks if you tire easily.
• Continue to practice deep breathing and coughing. If it hurts to cough, try holding a pillow against your belly as you cough.
• Do not drive until your health care provider approves.

General instructions

• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Take your temperature twice a day and write it down. If you develop a fever, this may be a sign that you have an infection.
• Do not drink alcohol.
• Have someone help you at home for 1 week or until you can do your own household activities.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever.
• You have increasing abdominal pain that is not relieved with medicine.
• You have nausea, vomiting, or diarrhea.
• You have pain when you urinate or you have blood in your urine.
• You have a rash on your body.
• You have pain or redness where your IV access tube was inserted.
• You have redness, swelling, or pain around an incision.
• You have fluid or blood coming from an incision.
• An incision feels warm to the touch.
• You have pus or a bad smell coming from an incision.

Get help right away if:

• You have weakness or light-headedness.
• You have pain, swelling, or redness in your legs.
• You have chest pain.
• You faint.
• You have shortness of breath.
• You have heavy vaginal bleeding.
• You have an incision that is opening up.

Summary

• Recovery time from this procedure will depend on the type of procedure you had and your general overall health prior to the procedure.
• If you were prescribed an antibiotic medicine, use it as told by your health care provider. Do not stop using the antibiotic even if you start to feel better.
• Do not douche, use tampons, or have sexual intercourse until your health care provider approves.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.