Myomectomy
Information for patients and carers
This information gives general advice about myomectomy procedures for uterine fibroids; your
doctor will discuss the specific options that are appropriate for you.
Alternatives to myomectomy may include medical treatments, hysterectomy, fibroid
embolization, endometrial ablation or no treatment.
What is a myomectomy?
A myomectomy operation aims to remove your fibroid(s) without removing the uterus (womb). A
myomectomy can be done in different ways, including:
1. Abdominal myomectomy: where a cut is made on the abdomen to remove the fibroid(s).
This cut may be across the abdomen (transverse) or a vertical cut (midline)
2. Laparoscopic myomectomy: a keyhole procedure where the fibroid is removed and then
cut into small pieces with a special instrument called a morcelator
3. Hysteroscopic removal: if fibroids are situated near the lining of the womb they can
sometimes be removed by inserting a telescope into the womb via the vagina and
removing the fibroids through the neck of the womb (see separate information sheet).
The type of myomectomy will depend on your personal circumstances, size and position of the
fibroids and will be discussed with you by your gynaecologist before your operation.
You will usually need treatment prior to your operation to reduce the size and blood
supply of the fibroids. This usually takes 3 months of treatment and this may be tablets
or an injection. You will usually need an anaesthetic for a myomectomy. This is usually a
general anaesthetic, rarely a regional anaesthetic (spinal or epidural) may be required.
Hysteroscopic removal can sometimes be performed without an anaesthetic.
Risks of a myomectomy
The serious and frequently occurring risks of a myomectomy are detailed below.
Women who are obese, have large fibroids or endometriosis, have had previous surgery or who
have pre-existing medical conditions will have an increased risk of serious or frequent
complications.
At the time of the operation
Some bleeding is expected during a myomectomy. If it is heavier than expected a blood
transfusion may be required. Occasionally, the bleeding is so heavy that a hysterectomy is
required to stop the bleeding (approximately 3% of cases). This will result in loss of fertility.
The uterus is surrounded by other organs that may be damaged during a myomectomy. This
includes the bladder, the bowel and the ureters (the tubes that connect the kidneys to the
bladder). The risk of this happening is approximately 8 in 1000. If detected during the operation
it will be repaired and will result in a longer recovery period.
Occasionally at the time of myomectomy, it is not possible to safely remove all of the fibroids.
At laparoscopic myomectomy the fibroids may need to be morcelated (cut into smaller pieces)
for removal. This can lead to difficulties assessing the tissue to ensure cancer is not present. In
addition, small parts of the fibroid may remain inside the abdomen and this carries a small risk
of fibroids redeveloping.
Myomectomy v2
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Review date: May 2024 Page 1 of 2
In the first week
Bleeding is possible after a myomectomy and some women have to return to theatre for a
second operation.
Infection of the bladder, wound or chest can occur after a myomectomy and women may require
antibiotic treatment.
Blood clots in the legs or lungs may occur after a surgical procedure. Calf compression
stockings and blood thinning medication are recommended in most women to minimise the risk
of these clots occurring.
A catheter is required during a myomectomy and is usually removed the day after your
operation. When this is removed after the operation, the bladder may not function normally
immediately. If this occurs, reinsertion of the catheter may be necessary. Long-term bladder
dysfunction is uncommon.
More long term
As the uterus is not removed during a myomectomy, fibroids may regrow or new fibroids may
develop.
Numbness and tingling can occur around the scar(s). This usually resolves within a few weeks
but can take months to improve.
Adhesions (attachments between the organs in the abdomen) may occur due to surgery. These
can cause pain and may make future surgery more difficult.
If you become pregnant after having a myomectomy operation, the pregnancy may be more
risky and a caesarean section may be recommended/ required for delivery. Your gynaecologist
will discuss this with you before and after your operation.
Recovery after myomectomy
Every woman has different needs and recovers in different ways. Your own recovery will
depend on:
• How fit and well you are before your operation
• The exact type of myomectomy that you have
• How smoothly the operation goes and whether there are any complications.
After your operation you will have a catheter in your bladder, this will be removed when you are
mobile. Some women may also have a drain in their abdomen. This small tube is usually
removed by 24h after your operation. Some women will also have fluids into a small drip in their
hand or arm. This will be stopped when you are able to drink. All women will be prescribed
painkillers, these may be administered into a drip or be taken as tablets.
In general, women having an abdominal myomectomy can expect to be in hospital for 2-3 nights
and those having a laparoscopic procedure for 1 night. Women having an abdominal
myomectomy should not do any heavy lifting for 6 weeks and should not expect to return to
work for at least 4 weeks. Women having a laparoscopic procedure should not expect to return
to work for at least 2 weeks.
Contact Telephone Numbers:
RIE Gynaecology Triage 0131 242 2551 St John’s Hospital 01506 524112
Chalmer’s Centre 0131 536 1070 NHS 24 (for urgent 111
advice when your
GP is closed)
Myomectomy v2
Approved by: Clinical Policy, Documentation & Information Group LOT 1463
Review date: May 2024 Page 2 of 2
