Uterine Fibroid Surgery

What are uterine fibroids?

Uterine fibroids are benign (noncancerous) tumors that can grow in three places: Under the uterus’ lining, inside the wall of the uterus or outside the uterus. Fibroids are very common in women during their reproductive years and can result in infertility.

Uterine Fibroids | Bay Area Fertility Doctor | Types of uterine fibroids illustrationIn many cases of uterine fibroids, women don’t experience any symptoms. But when they do, symptoms can include greater than normal menstrual bleeding, abnormal periods, bleeding in the uterus, pain, frequent urination and, as stated, infertility. The picture to the left shows the types of uterine fibroids.

Surgery for uterine fibroid treatment

There are a number of surgical treatment options for uterine fibroids, but not every treatment is appropriate for every woman’s situation. The size and position of uterine fibroids, the woman’s particular health issues and her interest in getting pregnant in the future will all affect how a doctor treats the fibroids.

Uterine fibroid surgery can range from minimally invasive procedures with only a few days’ recovery time to more invasive procedures like hysterectomy, which involves removing the uterus. This surgery does not allow a woman to get pregnant in the future and is often only one of several treatment options.

Women who hope to become pregnant after their surgery can consider surgical alternatives to hysterectomy such as myomectomy, which removes the fibroids (also known as myomas) but leaves the uterus in place. Many women experience improved fertility after these procedures, although the ability to get pregnant is not guaranteed.

There are three types of myomectomy procedures: laparoscopy, hysteroscopy and open. Each is suited to different kinds of fibroids and involves different risks and recovery times.

Myomectomy – laparoscopy

During laparoscopy, the doctor makes several small incisions near the bellybutton and inserts a small, lighted viewing device into the abdomen. This viewing device has a camera the doctor uses to identify and remove the fibroids with special medical instruments.

Since the incisions during surgery are only 8 to 12 mm in length, laparoscopy is considered a minimally invasive procedure. Most women can resume work a week after undergoing laparoscopy.

Myomectomy –  hysteroscopy

Operative hysteroscopy is a minimally invasive surgery commonly used when uterine fibroids bulge into the uterine cavity. Hysteroscopy can be used solely as a diagnostic procedure to identify the extent of a fibroid issue. During operative hysteroscopy, a surgeon inserts a hysteroscope, which is a thin lighted tube, into the vagina and guides it through the cervix into the uterus.

Once the hysteroscope has reached the uterus, the surgeon can identify the fibroids and use instruments to surgically remove the fibroid. Recovery time for this procedure is also very short – many patients resume normal activity one to two days after the surgery.

Open myomectomy

Unlike hysteroscopic and laparscopic surgery, open myomectomy is not a minimally invasive procedure. Open myomectomy may be the best course of treatment when a woman has many uterine fibroids or when fibroids are large in size.

A surgeon performs open myomectomy by making a larger incision in the abdomen to remove the fibroids. Because of the size of the incision, recovery time for an open myomectomy is much longer, generally four to six weeks.

Alternatives to fibroid surgery

In addition to surgical treatments, there are a number of alternative treatments that may help to stop fibroid growth or even shrink them. But in general nonsurgical treatments can negatively affect future fertility and a woman’s likelihood of getting pregnant.

Comparing treatments for uterine fibroids

The following charts compare different surgical and nonsurgical uterine fibroid treatments. Specifically, each chart examines a treatment’s invasiveness, recovery time, effect on future fertility and delivery options, considerations and risks. Women considering different uterine fibroid treatment options may want to consider the importance of each factor before coming up with a treatment plan with their physicians.

View & download our treatment comparison chart

Myomectomy – laparoscopy

Minimally invasive? Yes
Number of days out of work 7
Future fertility Good
Need for cesarean delivery Usually recommended
Considerations Best suited when the number of fibroids is limited
Risks Low risk of bleeding & infection, low risk of tubal scarring

Myomectomy – hysteroscopy

Minimally invasive? Yes
Number of days out of work 1-2
Future fertility Very good
Need for cesarean delivery Not necessary
Considerations Only suitable for fibroids that are primarily in the uterine cavity; effective for treating abnormal uterine bleeding, recurrent pregnancy loss and infertility
Risks Very low complication rate; risks include bleeding, excess fluid absorption, uterine perforation, infection

Myomectomy – open

Minimally invasive? No
Number of days out of work 4-6 weeks
Future fertility Improved
Need for cesarean delivery Recommended
Considerations Indicated when the uterine size is very large or the number of fibroids is very high
Risks Moderate risk of bleeding, infection, tubal scarring; lower risk of readmission

MRI-guided focused ultrasound (MRgFUS)

Minimally invasive? Yes
Number of days out of work 1-2
Future fertility Labeling for the device now allows treatment in women considering future pregnancy but is generally recommended for women who have completed their family
Need for cesarean delivery Not studied, possible increased risk of uterine rupture
Considerations 40% of patients have medical contraindications for this technique. There is a higher failure rate with larger fibroids. Newer treatment with limited long-term outcomes known.
Risks Low risk of fever, skin burns, nerve damage, blood clots

Umbilical artery embolization

Minimally invasive? Yes
Number of days out of work 3-5
Future fertility Possible impairment
Need for cesarean delivery Few cases studied, possible increased risk of miscarriage, preterm delivery, uterine rupture and bleeding after delivery
Considerations Best considered if surgery is not safe for the patient and considered for reduction of symptoms; higher failure rate with larger and multiple fibroids
Risks Higher complication rate (infection, pain) & high readmission rate compared with myomectomy

Laparoscopy with radio frequency

Minimally invasive? Yes
Number of days out of work 3-5
Future fertility No recommendation
Need for cesarean delivery Not studied, possible increased risk of uterine rupture
Considerations Best suited when the number of fibroids is limited; limited information on long-term outcomes
Risks Low risk of bleeding, infection, tubal scarring; risk of incomplete destruction of fibroid

Hysteroscopy with endometrial ablation

Minimally invasive? Yes
Number of days out of work 1-2
Future fertility Significantly impaired and usually not possible to get pregnant
Need for cesarean delivery N/A
Considerations Suitable for small fibroids in the uterine cavity; high rate of need for retreatment
Risks Low risk of bleeding, infection

Hysterectomy

Minimally invasive? No
Number of days out of work 4-6 weeks
Future fertility Not possible to conceive after treatment
Need for cesarean delivery N/A
Considerations Indicated when there is a concern for cancer or other conditions only corrected by complete removal of the uterus
Risks Moderate risk of bleeding, infection, blood clots