DURATION: 1-2 hours
ANAESTHESIA/PAIN RELIEF: General anaesthetic.
RECOVERY TIME: Up to 6 weeks.
SPECIAL REQUIREMENTS: Refrain from eating or drinking for 6 hours before the procedure; you may be asked to stop taking certain medications in the days leading up to the procedure.
SUITABLE FOR: Patients seeking the removal of fibroids to reduce pain and discomfort, as well as to improve the chances of pregnancy.
Of the myriad causes for heavy periods, pain during intercourse, pelvic pain, urinary frequency and feelings of pressure in the pelvis fibroids are a common cause. As non-cancerous growths that can develop in the womb and the pelvis at any time. They are very common with up to 50 % of women having some fibroid change. Fibroids can vary greatly in size, so much so that, in some cases, those affected by them don’t experience any symptoms whereas other women have debilitating symptoms of menstrual dysfunction, pain or discomfort as a result of their presence. Unfortunately for some women the position of the fibroids in the uterus or the size of the fibroid may be associated with fertility issues.
For women with significant symptoms or fertility issues a myomectomy may be the best course of treatment.
Fibroids
Fibroids are a benign growth of the womb. Some women such as Afro-Caribean women they are more susceptible to fibroids than others. In fact women of colour are 3 to 5 times more likely to be affected by fibroids than white women.
The underlying cause of fibroid growth is due to a group or clone of cells in the muscle of the womb becoming overgrown due to oestrogen hormone stimulation. As a consequence fibroids tend to grow in the fertile years before the menopause and may rapidly grow in pregnancy. After the menopause fibroids normally shrink in size as the levels of oestrogen fall. Unfortunately Hormone Replacement Therapy (HRT) may make them grow again.
If a fibroid grows after the menopause and the woman is not on HRT then this could be a sign of a rare condition Leiomyosarcoma. This is a cancer which arises from a fibroid occurs in an estimated 1:2800 women which is very rare when compared to breast cancer which affects around 1:9 women.
In some cases, fibroids can be a source of great pain and have a significant impact on everyday living, particularly during menstruation. There may even be reason to suspect that fibroids are responsible for the inability of a woman to get pregnant. The presence of fibroids in the womb or around the reproductive system can be identified initially by a simple ultrasound scan.
The importance of a myomectomy
As fibroids can lead to many undesirable symptoms and could be a cause of fertility problems, it’s important to know that these benign growths can be removed in a process known as a myomectomy. Myomectomy has been shown to be more effective treatment than an alternative treatment fibroid embolisation particularly in relation to quality of life after the procedure (New England Journal of Medicine 2020;383:440-451). A myomectomy is a procedure that focuses on the extraction of any number of fibroids in order to eliminate new and chronic areas of pain, reduce excessive menstrual bleeding and improve the chances of becoming pregnant.
How is a myomectomy carried out?
Although similar to a hysterectomy, a myomectomy is defined by its focus on the removal of just the fibroid growths, and not the reproductive organs as a whole.
The position number and size of the fibroids will determine the optimal way the fibroids should be removed.
If the fibroid is adjacent to the lining of the womb and it is 5cm or less then in most cases it can be easily removed in clinic painlessly using a special telescope (hysteroscope) with a cutting device called MyoSure passed into the cavity of the womb which can remove the fibroid in 5 to 10 minutes.
If the fibroid is significantly greater than 5cm then a different device Sonata may be used to ablate the effectively fibroid using electrical energy.
If the fibroid is deep in the muscle of the womb but still distorting the womb then the fibroid can be removed either laparoscopically or robotically. The benefit of this is the cuts on the abdomen are small (5-10 mm) so early recovery is faster than traditional open surgical myomectomy through a large cut.
If the uterus is overtaken by multiple large fibroids then sometimes it is wise to opt for a traditional open myomectomy as complete clearance of the fibroids in one operation is more likely to be achieved in this situation.
Choosing a myomectomy
If fibroids are having a serious impact on your physical and mental health – or could be the cause of your inability to conceive, a myomectomy operation could dramatically improve things . Choosing to undergo a myomectomy will allow you to keep your reproductive system intact and significantly boost your chances of having children. As the founder of Advanced Gynaecology UK, Mr Francis Gardner has been performing myomectomy procedures for more than a 15 years. With unrivalled knowledge of the female anatomy, and someone well-known for their steadfast dedication to all of their patients, it’s little wonder that so many women place their trust in Mr Gardner.
To book in for your myomectomy procedure with Mr Gardner, get in touch today.
FAQ’s
A myomectomy is only offered to patients who have been diagnosed with fibroids who have symptoms which match the size and position of the fibroids. The existence of fibroids will normally be determined by undergoing a number of routine tests including ultrasound but potentially also MRI.
Unlike a hysterectomy, a myomectomy doesn’t necessitate the part or full removal of the body of the womb. In this procedure, only fibroids are removed to allow the reproductive system to function more efficiently and to reduce any painful symptoms that may be associated with these growths. A hysterectomy can still be undertaken should you decide you no longer want to have any children.
As with any form of surgery, a myomectomy carries a certain amount of risk. Complications are recognised but can include bleeding, scarring, infections, organ damage and adverse reactions if a general anaesthetic is required.
If the Myomectomy is performed hysteroscopically then there is no real recovery. Most women can leave the clinic 30 minutes after completion of the procedure and stop bleeding after the procedure within 7 days. It is advised to avoid sexual intercourse for 7 days and avoid pregnancy for 6 weeks.
If a laparoscopic or robotic myomectomy is performed than recovery is around 4-6 weeks. A traditional open myomectomy may require 6 to 12 weeks recovery depending on whether the cut on the abdomen is up and down or across the abdomen. Pain medication will be required particularly in the first few days and perhaps upto two weeks after these procedures. Some bleeding can be expected and it is advisable to avoid tampons but using sanitary towels as an alternative. It is advised to avoid sexual intercourse for 7 days and avoid pregnancy for 6 weeks.