Laparoscopic surgeon and gynaecology ultrasound specialist, Mr Gnanachandran explains why a myomectomy is often the best option for relieving fibroid problems for patients who want to conceive.
What is a Myomectomy?
Why might someone need a Myomectomy?
Although fibroids are quite common and usually benign, they can sometimes cause a number of health problems. These can include heavy and/or painful periods, causing disturbances in lifestyle and anaemia, tiredness.
Fibroids can be a reason for the difficulty in conceiving and pregnancy complications like pre-term deliveries or abnormal presentations, subfertility and infertility. In a small number of cases a myomectomy may also be performed in order to solve bladder functionality issues Women experiencing these issues usually seek a myomectomy to alleviate pain and facilitate pregnancy.
What are the risks?
As with any surgery, myomectomy procedures do carry an element of risk for potential patients.
Some of the risks are standard for operations of this type, such as heavy bleeding, potential damage to other organs and prolonged surgery and blood transfusion.
Risks unique to myomectomy is the risk of hysterectomy (1- 4%) needing to be performed due to excessive bleeding, although this is an extremely rare occurrence at first myomectomy and selected cases. Also, other risks are recurrence of fibroids and scarring of the womb cavity. Possible post-surgery problems include persistent pain, haematoma (bruising), infection and blood clots.
The resultant scarring means it is essential that patients avoid any type of pregnancy. Including IVF, for up to 3-6 months after surgery.
What happens after surgery?
The amount of time spent in the hospital after surgery varies, with the type of surgery and the amounts of fibroids removed as being the main factors. If key-hole surgery is performed, the patient may be allowed to leave the same day or, if not the next, whereas patients are kept for at least 48 hours to 72 hours after open surgery. The patient´s heart rate will be monitored in both cases, while fluid and antibiotics are usually administered via IV for 24 hours. A catheter may also need to be fitted in order to drain urine.
Are there alternatives to a myomectomy?
While this type of surgery has a very high success rate, there are many reasons why a patient may choose not to go ahead with it. One of the alternatives is GNRH or Esmya medications that aim to decrease the fibroid size; although this method is only effective for smaller fibroids, larger growths may still require surgery. It has also been known to cause menopausal symptoms.
Hormonal treatments are another option but they’re not ideal when the fibroid affects the womb cavity or if the fibroids are more than 4cm in length.
Other alternatives include a hysterectomy or uterine artery embolization but are generally only recommended to those who have completed their families due to potential fertility issues.
Mr Gnanachandran has extensive experience in scanning in gynaecology, especially for fibroids and ovarian cysts. In addition, he is an accredited IOTA scanner for ovarian mass and participates in ovarian cancer studies. Please visit his profile to book a consultation.