Surgery to remove fibroids: When to do, risks and recovery

Surgery for the removal of fibroids is performed when the woman has symptoms such as severe abdominal pain and abundant menstruation, which do not subside after using medications. However, the woman’s interest to become pregnant should be taken into consideration because surgery can hinder future pregnancy. Surgery is not necessary if the symptoms can be controlled with medications or when the woman is in menopause.

Fibroids are benign tumours that arise in the uterus in women who are in the childbearing age. It causes intense discomfort such as menstrual bleeding and intense cramps, which are difficult to handle. Medications can decrease their size and control the symptoms, but when this fails to happen, the gynaecologist may recommend the removal of the myoma through surgery.

Types of surgery to remove myoma

Myomectomy is the surgery performed to remove myoma from the uterus, and there are 3 different ways to perform myomectomy:

• Laparoscopic myomectomy: Small holes are perforated in the abdominal region, through which a microcamera passes and the necessary instruments are used for the removal of the myoma. This procedure is only used in case the myoma is located on the external wall of the uterus.
• Abdominal myomectomy: This is a kind of “caesarean section”, where a cut is made on the region of the pelvis, which goes to the uterus, allowing the removal of the myoma.
• Hysteroscopic myomectomy: It is where the doctor introduces the hysteroscope through the vagina and removes the myoma, without the need for cuts. It is only recommended in case the myoma is located inside the uterus with a small part into the endometrial cavity.

Surgery for myoma is usually done to control the symptoms of pain and excessive bleeding in most cases. However, for some women, the surgery may not be definitive as a new myoma may develop somewhere else in the uterus 10 years later. Therefore, the doctor may recommend that the uterus be removed rather than the myoma itself.

The doctor may also perform ablation of the endometrium or make an embolization of the arteries that nourish the fibroids so long as it is a maximum of 8cm or the myoma is located in the posterior wall of the uterus. This is because, this region has many blood vessels and cannot be cut through surgery.

How is the recovery from surgery

The recovery is usually fast but the woman should rest for at least a week for proper healing and they should avoid any form of physical activity during this period. Sexual intercourse should only be done 40 days after surgery to prevent pain and infection. One should return to the doctor if other symptoms arise such as smell in the vagina, vaginal discharge and very intense bleeding of bright red colour.

Possible risks of surgery to remove myoma

When surgery is done by an experienced gynaecologist the woman should relax as the techniques used are safe for health and other risks can be controlled. Nevertheless, during myomectomy surgery, haemorrhage may occur and there may be need to remove the uterus. Some doctors claim that the scar left in the uterus can favour uterine disruption during pregnancy or at the time of delivery, but it rarely happens.

Before performing abdominal surgery, if the woman is overweight, it is necessary to lose weight to decrease the risks of surgery. In case of obesity, the uterus may be removed through the vagina.

Moreover, study shows that some women, despite having their uterus retained are less likely to become pregnant after surgery. This is because of cicatricial adhesions which are formed due to surgery. It is believed that half of the cases, surgery may prevent pregnancy in the first 5 years after the procedure.