Myomectomy in Detail – Symptoms, Treatment Options, Recovery and Fertility
Myomectomy is a surgical procedure used to remove uterine fibroids (also called myomas or leiomyomas) while preserving the uterus. For many women suffering from symptoms of fibroids who still wish to maintain fertility or avoid hysterectomy, myomectomy offers a targeted and uterus-conserving option.
Information and consultation: +90 541 998 34 34 – Istanbul, Turkey
In the UK, myomectomy is considered where less invasive medical therapies have failed or are inappropriate. On NHS and in private settings alike, the decision rests on fibroid size, number, location, and the patient’s reproductive goals.
Myomectomy is a widely preferred solution for women with fibroids who experience heavy bleeding, pelvic pain, or pressure symptoms but do not wish to lose their uterus.
What Are Uterine Fibroids?
Fibroids are benign (non-cancerous) growths arising from the muscle and connective tissue of the uterus (womb). They are also called leiomyomas or myomas. Many women develop fibroids during their reproductive years, but many fibroids remain asymptomatic and go unnoticed.
Estimates suggest that two in three women may develop fibroids by the time they reach menopause, although not all will require treatment.
Fibroids can be categorised by their position in or on the uterine wall: intramural (within the muscle wall), subserosal (outside the uterus), submucosal (protruding into the uterine cavity), and pedunculated (attached by a stalk).
Fibroids may cause symptoms such as heavy or prolonged menstrual bleeding, pelvic pain or pressure, frequent urination, constipation, pain during intercourse, and reproductive problems such as infertility or miscarriage.
When Is Myomectomy Recommended?
Myomectomy is not suitable for every fibroid case. Gynecologists consider factors like symptom severity, fibroid characteristics, fertility goals, and overall health.
Myomectomy is recommended when medical therapy has failed, when symptoms are severe and impacting quality of life, or when the patient wishes to preserve fertility.
Fibroids that cause pain, pressure, or excessive bleeding and are surgically accessible can be effectively removed while preserving the uterus.
If fibroids are extremely large, numerous, or in difficult positions, or if fertility is no longer a priority, sometimes hysterectomy or embolisation may be preferred.
Types of Myomectomy
Abdominal (Open) Myomectomy
This involves a larger incision—usually a “bikini line” (transverse) or vertical cut in the lower abdomen. The surgeon opens the uterus, removes the fibroids, and repairs the uterine wall.
It is used for large or multiple fibroids. Recovery is longer, typically 4–6 weeks, with more postoperative discomfort.
Laparoscopic (Keyhole) Myomectomy
This minimally invasive approach uses several small incisions. A laparoscope and fine instruments remove the fibroids, often in pieces. Recovery is faster, hospital stay shorter, and scarring minimal.
It may not be suitable for very large or numerous fibroids.
Hysteroscopic Myomectomy
Used for submucosal fibroids (inside the uterine cavity). A hysteroscope is inserted through the vagina and cervix, with no external incision. Recovery is quick and hospitalisation is usually not required.
Robotic Myomectomy
Performed in some centres using robotic technology, which increases surgical precision while keeping the benefits of minimally invasive surgery.
Advantages and Limitations
Advantages
Myomectomy preserves the uterus, allowing for future pregnancy. It relieves heavy bleeding, pain, and pressure symptoms and often improves fertility outcomes. Minimally invasive approaches provide faster recovery and smaller scars.
Limitations and Risks
Fibroids can recur, and further surgery may be needed. Risks include bleeding, infection, injury to nearby organs, anaesthetic risks, uterine scarring, or rare conversion to hysterectomy.
In rare cases, uterine rupture may occur in pregnancy, especially if conception happens too soon after surgery.
Preparing for Myomectomy
Before surgery, patients undergo blood tests, imaging (ultrasound or MRI), and general health assessment. Iron supplements may be given if anaemia is present.
Doctors may prescribe temporary hormone therapy (GnRH analogues) to shrink fibroids and reduce bleeding during surgery.
Patients are advised to stop smoking, maintain a healthy diet, and follow fasting instructions before surgery.
The Surgical Procedure
Myomectomy is performed under general anaesthesia. Depending on the technique, the surgeon makes either a small keyhole incision, an open abdominal incision, or uses a hysteroscope through the vagina.
The fibroids are located, blood flow to them is controlled, and each fibroid is carefully removed. The uterine wall is repaired in layers to preserve its strength.
Surgery can take from one to several hours, depending on the number and size of fibroids.
Recovery and Aftercare
Hospital stay varies from same-day discharge (hysteroscopic) to 2–5 days (open). Patients are given pain relief, monitored for bleeding or infection, and encouraged to move early to prevent blood clots.
At home, patients should rest, avoid heavy lifting, maintain hygiene, and follow dietary advice. Full recovery usually takes 6–8 weeks, but it can be shorter after minimally invasive surgery.
Sexual activity should be avoided until the uterus is fully healed, usually 4–6 weeks.
Pregnancy After Myomectomy
Many women conceive successfully after myomectomy. Doctors usually advise waiting 3–6 months before trying to conceive.
Pregnancy after myomectomy should be monitored carefully, and in some cases, a caesarean section may be recommended to avoid uterine rupture.
Most women have normal pregnancies and healthy babies after the procedure.
Recurrence and Long-Term Outlook
Fibroids may recur in 15–30% of women within 5–10 years. Regular follow-up and ultrasound checks are advised.
Healthy lifestyle, weight management, and hormonal balance can help reduce recurrence risk.
Myomectomy is a highly effective solution for symptom relief and fertility preservation, especially when performed by experienced surgeons.
Comparison with Other Treatments
Hysterectomy
Removes the uterus completely, eliminating fibroids permanently but ending fertility.
Uterine Artery Embolisation (UAE)
A non-surgical method blocking the blood supply to fibroids, causing them to shrink. Quicker recovery but less suitable for women planning pregnancy.
Medical Therapy
Hormonal treatments and IUDs can help manage symptoms but rarely offer a permanent solution.
Endometrial Ablation
Destroys the uterine lining to reduce bleeding. Not suitable for large fibroids or women wishing to conceive.
Frequently Asked Questions
Is myomectomy painful?
Discomfort is normal after surgery but controlled with medication. Laparoscopic methods cause less pain than open surgery.
Will I still have periods?
Yes. Myomectomy preserves the uterus, so menstruation continues, usually lighter than before.
How long is recovery?
Recovery varies by technique: 1–2 weeks for laparoscopic or hysteroscopic, 4–6 weeks for open surgery.
Can all fibroids be removed?
Not always; very small or deep fibroids may remain if they pose risk during removal.
Will fibroids come back?
Recurrence is possible, but many women enjoy long-term relief after myomectomy.
What is the cost in the UK?
Private myomectomy procedures in the UK generally cost between £5,000–£10,000 depending on complexity.
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Summary
Myomectomy is a uterus-preserving surgery designed to relieve fibroid symptoms and maintain fertility. It can be performed through open, laparoscopic, hysteroscopic, or robotic methods.
Although there are risks such as bleeding or recurrence, myomectomy offers an effective and safe option for women seeking to retain their uterus.
If you are considering myomectomy, consult an experienced gynaecologist to discuss which approach suits you best. Information and consultation: +90 541 998 34 34 – Istanbul, Turkey
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