The female reproductive system has two ovaries, two fallopian tubes and a uterus (womb).

Ovaries are where eggs are made.
• The fallopian tubes provide a pathway for the eggs to travel from the ovaries to the uterus.
• The uterus is where a baby grows during pregnancy.

Uterine fibroids are noncancerous (benign) growths that can grow:

• On the inside of the uterus
• Within the wall of the uterus
• On the outside of the uterus

These fibroids can vary widely in size and symptoms they cause. Often, they do not cause any symptoms.

A myomectomy is surgery to remove one or more fibroids from a women's uterus. The uterus itself is not removed. The fibroid(s) can be removed through an incision in the lower abdomen along the bikini line (straight across or horizontal) or in the area of the belly button (straight down or vertical). The type of incision depends on the:

• Size, number and location of the fibroids
• Size and shape of the vagina
• Training of the surgeon

This care path contains the costs of a myomectomy done through an open incision. However, there are times when the surgeon can perform a myomectomy through a laparoscope. In those cases, the fibroid is removed using small medical instruments and a camera inserted into three or four small cuts in the abdomen.

You and your healthcare provider should discuss the reasons for the myomectomy and what alternative treatments might be available to you.

• In most cases, a woman can still have children after a myomectomy. Therefore, this surgery is a good option for women with severe symptoms, who want to have children in the future.
• However, women who have had a myomectomy may require a cesarean section if they become pregnant. This is to prevent a rupture of the uterus during labor.

Uterine fibroids are very common in women who still have their periods. They often shrink after menopause begins, which makes monitoring them with periodic pelvic exams an option for some women. Other treatment options include:

• Medications, such as over-the-counter pain relievers and birth control pills
• Procedures to destroy the fibroid tissue
• Surgery to remove the fibroid tissue

The treatment option that is best for you may depend on a number of factors including:

• Your age
• Your overall health
• How bad your symptoms are
• Whether or not you plan on having children in the future
• Number and characteristics of the fibroid (s), such as size, location and rate of growth
• Your personal preferences

The majority of uterine fibroids do not require surgical treatment. Often, a course of non-surgical treatment is recommended before surgery. However, surgery may be needed if you have:

• Excessive vaginal bleeding
• Bleeding in between periods
• Severe cramps
• Symptoms related to the pressure fibroids can place on the bladder or bowel

Contact your healthcare provider if you have any of these symptoms. He or she will perform a physical exam, including an internal exam (pelvic exam) to check the uterus and other pelvic organs. Tests may be ordered, including:

• Lab work, to see if you are anemic
• Abdominal or vaginal ultrasounds, to evaluate your uterus and other pelvic organs
• A biopsy inside your uterus

Your healthcare provider may recommend removal of your uterine fibroids if you have severe symptoms that cannot be controlled with medication or non-surgical treatments. Prior to surgery, tell your healthcare provider about any medications you are taking (including over-the-counter medications and supplements). Ask about specific instructions you should follow before surgery. These may include:

• Medications you should not take before the surgery, such as blood thinners
• Regular medications you should take on the day of your surgery
• How many hours you should stop eating and drinking before surgery

If you are a smoker, you should quit smoking, as it can interfere with your recovery.

During your surgery, you will receive anesthesia to keep you comfortable and pain free.

• General anesthesia is the most common type of anesthesia for a myomectomy. With this type of anesthesia, you are put into a deep sleep and are unable to see, hear or feel anything.
• Other types of anesthesia may be used during this surgery, but they are less common.
• After an abdominal myomectomy you will likely spend a couple of days in the hospital.
• Full recovery from a myomectomy typically takes 4 to 6 weeks.
• You may need pain medication and help at home while you recover.

Contact your healthcare provider if you have symptoms of endometriosis. Be prepared to discuss your symptoms and how long you have had them.

• Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
• Make a list of your medications (including over-the-counter).
• Write down any questions, symptoms or concerns you want to talk about.
• If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).

Instructions (including medications and side effects) and follow-up plans. Your gynecologist should also let your primary care physician know the details of your surgery and treatment plan.

What should I ask my healthcare provider before having a myomectomy?

• What is my diagnosis and reason for the surgery? What non-surgical alternatives are available to me? What are the possible complications of each?
• What happens if I do not go through with the surgery?
• What are the chances my symptoms will return after surgery?
• Will my surgery interfere with my chances of having children?
• Is laparoscopic surgery an option for me? Why or why not?
• Is there any special preparation for the surgery? (If so, get clear instructions on what you need to do.)
• What tests are you recommending and why? Will the test results change my treatment plan? If not, then why do I need them?
• How will I feel after the surgery? Will I have to modify my activity? How long until I can get back to my normal activities?
• What is your experience in doing this type of surgery? What is your complication rate?

Before you go home, make sure you understand all home care instructions (including medications and side effects) and follow-up plans. Your gynecologist should let your primary care physician know the details of your surgery and treatment plan.

Source UHC.com

Also known as:

Uterine Fibroid Removal

Removal of Fibroid

Myomectomy

Hysterectomy

Fibroids

Fibroid Removal