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Risks
By Mayo Clinic staffMyomectomy has a low complication rate. Still, the procedure poses a unique set of challenges for your surgeon.
Risks of myomectomy include:
- Excessive blood loss. The uterus has a rich network of blood vessels, and fibroids stimulate growth of new vessels to obtain their own blood supply. So during myomectomy, surgeons must take extra steps to avoid excessive bleeding. These steps include blocking flow from the uterine arteries and injecting medications around fibroids to cause blood vessels to clamp down.
- Scar tissue. Incisions into the uterus to remove fibroids can lead to adhesions — bands of scar tissue that may develop after surgery. Within the uterus, adhesions may block implantation of a fertilized egg in the uterine lining, but this rarely happens. Outside the uterus, adhesions could entangle neighboring structures and lead to a blocked fallopian tube or a trapped loop of intestine.
- Development of new fibroids. Myomectomy doesn't eliminate your risk of developing more fibroids later. Tiny tumors (seedlings) that your doctor doesn't detect during surgery could eventually grow and cause symptoms. New tumors also can develop. Women who had only one fibroid have a lower recurrence rate than do women with multiple fibroids. If fibroids return, future treatment — a repeat myomectomy, hysterectomy or other procedure — may be necessary.
- Childbirth complications. Having had myomectomy surgery can pose some risk factors for delivery if you become pregnant. If your surgeon had to make a deep incision in your uterine wall, the doctor who manages your subsequent pregnancy may recommend cesarean delivery to avoid rupture of the uterus during labor.
- Inability to restore the structure of the uterus. To remove imbedded fibroids, the surgeon might cut into the muscular wall (myometrium), leaving a gap. Closing it requires stitches (sutures), usually in layers. Rarely, the surgeon must remove the uterus if bleeding is severe or if he or she can't reconstruct the uterus.
Strategies to prepare for possible surgical complications
To minimize risks of myomectomy surgery, your doctor may recommend:
- Iron supplements and multivitamins. If you have iron deficiency anemia from heavy menstrual periods, your doctor might recommend iron supplements and multivitamins to allow you to build up your blood count prior to surgery.
- Hormonal treatment. Another strategy to correct anemia is hormonal treatment before surgery. Your doctor may prescribe a gonadotropin-releasing hormone (Gn-RH) agonist, birth control pills, or other hormonal medication to stop or decrease your menstrual flow. When given as therapy, a Gn-RH agonist blocks the production of estrogen and progesterone, stopping menstruation and allowing you to rebuild hemoglobin and iron stores.
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Therapy to shrink fibroids. Some hormonal therapies such as Gn-RH agonist therapy can also shrink your fibroids and uterus enough to allow your surgeon to use a minimally invasive surgical approach — such as a smaller, horizontal incision rather than a vertical incision or a laparoscopic procedure instead of an open procedure. In most women, Gn-RH agonist therapy causes symptoms of menopause, including hot flashes, night sweats and vaginal dryness. However, these discomforts end when you stop taking the medication. Treatment generally occurs over several months prior to surgery.
Evidence remains unclear regarding the benefits of Gn-RH agonist therapy before myomectomy. Therapy can lead to higher hemoglobin and iron levels, higher red blood cell counts, less blood loss during surgery, and shorter operations. However, the shrunken, softened fibroids that result can be more difficult to detect and remove. Cost of the medication and its side effects must be weighed against the benefits.
- Banking blood. If your doctor is concerned that blood loss might be greater than average, you may be advised to have some of your blood drawn and stored before myomectomy in case you need a blood transfusion during surgery.
- The American College of Obstetrics and Gynecologists. Alternatives to hysterectomy in the management of leiomyomas. Obstetrics & Gynecology. 2008;112:387.
- Haney AF. Leiomyomata. In: Gibb RS, et al. Danforth's Obstetrics and Gynecology. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:916.
- The Practice Committee of the American Society for Reproductive Medicine. Myomas and reproductive function. Fertility and Sterility. 2008;90(suppl):S125.
- Stovall TG, et al. Myomectomy. http://www.uptodate.com/home/index.html. Accessed Jan. 20, 2009.
- Management of uterine fibroids: An update of the evidence. Rockville, Md.: Agency for Healthcare Research and Quality. http://www.ahrq.gov/downloads/pub/evidence/pdf/uterupdate/uterup.pdf. Accessed Jan. 26, 2009.
- Breech LL, et al. Leiomyomata uteri and myomectomy. In: Rock JA, et al. Te Linde's Operative Gynecology. 10th ed. Philadelphia, Pa.: Lippincott Williams & Wilkins; 2008:687.
- Khaund A, et al. Impact of fibroids on reproductive function. Best Practice & Research Clinical Obstetrics and Gynaecology. 2008;22:749.
- Seracchioli R, et al. Obstetric and delivery outcome of pregnancies achieved after laparoscopic myomectomy. Fertility and Sterility. 2006;86:159.
- Agdi M, et al. Endoscopic management of uterine fibroids. Best Practice & Research Clinical Obstetrics and Gynaecology. 2008;22:707.
