My Journey with Cushing’s disease
At 30 years old, I was fit, healthy and naturally a size 8–10. I knew my body well, which is why, when it started to
I must have refreshed my phone a thousand times that day waiting for the results of the intrauterine ultrasound to come through my patient portal. I decided to do it one more time before heading out to pick up my son from school. I had promised myself I would relax, but I needed to know if this one would actually show something.
By the time the doctor called to tell me I had fibroids, I had already seen the results, and I anxiously awaited the information he had for me. I should have been prepared to hear the word myomectomy in my list of options, but I wasn’t.
A Myomectomy is a procedure for uterine fibroid removal. In a study called, Pregnancy Rate after Myomectomy and Associated Factors among Reproductive Age Women Who Had Myomectomy at Saint Paul’s Hospital Millennium Medical College, Addis Ababa: Retrospective Cross-Sectional Study, we learn, “Uterine myoma occurs in 20-50% of reproductive age women. Uterine myomas may be associated with 5-10% of cases of infertility, but it is the sole cause or factor in only 2-3% of all infertility cases. Myomectomy is surgery done to remove myoma regardless of the methods.”
Uterine myomectomy can be performed in several different ways. Let’s look at them now.
In order to remove fibroids from the uterus, a doctor will have several options. Some factors that can go into the decision include:
Each person will have their own unique set of criteria. This will inform the medical team as to what options to offer.
Fibroid removal when done through open myomectomy is considered major surgery. This is because in order to perform this particular fibroid removal surgery, doctors need to make an incision, often referred to as a “bikini cut”, in the lower abdomen into the uterus. The fibroids will be taken out, and the incision sewn closed.
This procedure can take up to four hours. The doctor will have greater access to the fibroids, and can make sure they are all gone with minimal bleeding.
However, for those who have larger or many fibroids, it can be a good option. For others, accessing less invasive procedures might be beneficial.
Major surgery is not the only option for many seeking treatment for fibroid uterine surgery. Other, less invasive options can be provided.
Vaginal myomectomy is the least invasive way to remove fibroids. This involves inserting an instrument called a hysteroscope through the vagina and cervix into the uterus. A hysteroscope has a light and can remove tissue, including fibroids, from the uterus.
In a study called Hysteroscopic Myomectomy, we learn: “The size of the fibroids plays a crucial role in completing the hysteroscopic myomectomy in a single step. A diameter greater than 3 cm in type 2 myomas results in a higher risk of a multiple procedure.”
Removing fibroids with a hysteroscope could only take 30-60 minutes. However, the risks include needing repeat procedures or having to undergo other procedures to make sure the fibroids are all removed safely.
Abdominal myomectomy is laparoscopic fibroid removal. To perform this fibroids laparoscopic surgery, the doctor will make tiny incisions in the abdomen and insert a lighted tool with a camera called a laparoscope. Then the smaller tools can go in and remove the fibroids.
Robotic myomectomy is a type of laparoscopic myomectomy procedure. In this case, the medical team would use tiny instruments and a robot would be sent in to help remove the fibroids and even make repairs to the wall or lining of the uterus. These types of myomectomy procedures are minimally invasive, and have recovery times of 2-4 weeks.
Myomectomy for fibroids using laparoscopy can take 2-4 hours. The number of fibroids and their size can be a factor in how long it takes.
The largest a fibroid can be, in order for it to be able to be removed laparoscopically, is around 4 inches (9-10 cm in diameter). Any bigger and it will need to be treated another way.
Fibroids can cause trouble for many people with uteruses. Symptoms can include:
Fibroids, when left untreated can grow in size, and if someone has one fibroid, they could develop more. Those who have symptoms from fibroids may want to look into treatment.
Most patients who undergo surgery for fibroids are between 35-41 years in age. In a study called, Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with Uterine Fibroids, we learn: “The average age for patients with the three myomectomy subtypes was 36.5 years for abdominal, 37.0 years for laparoscopic, and 41.0 years for hysteroscopic.”
You may be wondering how long it takes the uterus to recover after myomectomy. Recovering from myomectomy can take anywhere from 2-6 weeks. The type of myomectomy surgery the person has, and their individual healing will both be at play on the timeline.
Research from a study called, Uterine Fibroids: Surgery, shows that about 90 out of 100 women who have this procedure are still satisfied with the results one to two years afterwards. In up to 20 out of 100 women, fibroids grow again within the first few years after the procedure.
Many women never see fibroids grow again after surgery. For me, I had a hysterectomy which removed all possibilities for future uterine fibroids. However, hysterectomy also removes the possibility of pregnancy.
The success rates for becoming a parent after uterine fibroid surgery are high. According to one study, The Benefit of Myomectomy in Women aged 40 Years and Above: Experience in an Urban Teaching Hospital in Nigeria, “There was complete resolution of symptoms in 35.9% of those who required symptomatic relief, and term pregnancies were recorded in 72.7% of patients with pregnancy complications.”
The same study concluded: “Myomectomy is the recommended treatment of uterine fibroids in women aged 40 years and above with infertility and who wish to become pregnant. If there is no need for further fertility preservation, hysterectomy should be offered.”
I know first hand how scary and problematic fibroids can be. The odds are good though, that surgery can provide relief. The preservation of future goals can also be a wonderful side effect.
Many people go on to live healthy and unencumbered lives following fibroid removal. Some even see their dreams of having a baby come true.
As always, if you are having symptoms that could be related to fibroids, talk to your doctor. Your medical team can assess your needs, taking your history and future into consideration, and help you achieve the wellness you deserve.
Jeldu, M., Asres, T., Arusi, T., & Gutulo, M. G. (2021). Pregnancy Rate after Myomectomy and Associated Factors among Reproductive Age Women Who Had Myomectomy at Saint Paul’s Hospital Millennium Medical College, Addis Ababa: Retrospective Cross-Sectional Study. International journal of reproductive medicine, 2021, 6680112. https://doi.org/10.1155/2021/6680112
Obed, J. Y., Bako, B., Kadas, S., Usman, J. D., Kullima, A. A., & Moruppa, J. Y. (2011). The benefit of myomectomy in women aged 40 years and above: Experience in an urban teaching hospital in Nigeria. Nigerian medical journal : journal of the Nigeria Medical Association, 52(3), 158–162. https://doi.org/10.4103/0300-1652.86125
Davis, M. R., Soliman, A. M., Castelli-Haley, J., Snabes, M. C., & Surrey, E. S. (2018). Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with Uterine Fibroids. Journal of women’s health (2002), 27(10), 1204–1214. https://doi.org/10.1089/jwh.2017.6752
Piecak, K., & Milart, P. (2017). Hysteroscopic myomectomy. Przeglad menopauzalny = Menopause review, 16(4), 126–128. https://doi.org/10.5114/pm.2017.72757
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Uterine fibroids: Surgery. 2014 Oct 22 [Updated 2017 Nov 16]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279531/
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