Myoma is another name for a fibroid. In women whose fibroids cause problems (generally bleeding or pain) and who still want to keep their uterus, a myomectomy (removal of myoma) may be recommended by their physician. Occasionally a myomectomy is suggested to treat infertility. Some myomectomies can be done through a laparoscope or hysteroscope, some need to be done through a larger incision or cut on the abdomen.
Surgeons often recommend hormone treatment with a drug called leuprolide (Lupron) two to six months before surgery in order to shrink the fibroids and make them less vascular (prone to bleeding). This makes the fibroids easier to remove. In addition, Lupron stops menstruation, so women who are anemic have an opportunity to build up their blood count. While the drug treatment may reduce the risk of excess blood loss during surgery, there is a small risk that smaller fibroids might be missed during myomectomy, only to enlarge later after the surgery is completed.
Patients may need four to six weeks of recovery following a standard myomectomy before they can return to normal activities. Women who have had laparoscopic or hysteroscopic myomectomies, however, usually recover completely within one to three weeks.
- Blood loss
- Weakening of the uterine wall to the degree that future deliveries need to be performed via cesarean section
- Adverse reactions to anesthesia
- Internal scarring (and possible infertility)
- Reappearance of new fibroids
Note: - There is a risk that removal of the fibroids may lead to such severe bleeding that the uterus itself will have to be removed.
Removal of uterine fibroids will usually improve any problems that the patient may have been having, including abnormal bleeding and pain. Under normal circumstances, a woman who has had a myomectomy will be able to become pregnant, although she may have to deliver via cesarean section if the uterine wall has been weakened by removal of the fibroid.
Hysterectomy (partial or full removal of the uterus) is a common alternative to myomectomy. The most frequent reason for hysterectomy in the United States is to remove fibroid tumors, accounting for 30% of all hysterectomies. Fibroid embolization is a less-invasive procedure in which blood vessels that feed the fibroids are blocked, causing the growths to shrink. The blood vessels are accessed via a catheter inserted into the femoral artery (in the upper thigh) and injected with tiny particles that block the flow of blood. The fibroids subsequently decrease in size and the patient's symptoms improve.
Note: - This procedure is done by a specially-trained radiologist, not the gynecologist. The gynecologist will refer a woman to the appropriate radiologist.