Myomectomy has a low complication rate. Still, the procedure poses a unique set of challenges. Risks of myomectomy include:
- Excessive blood loss. Many women already have low blood counts (anemia) due to heavy menstrual bleeding, so they're at a higher risk of problems due to blood loss. Your doctor may suggest ways to build up your blood count before surgery. During myomectomy, surgeons take extra steps to avoid excessive bleeding, including 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. Outside the uterus, adhesions could entangle nearby structures and lead to a blocked fallopian tube or a trapped loop of intestine. Rarely, adhesions may form within the uterus and lead to light menstrual periods and difficulties with fertility (Asherman's syndrome). Laparoscopic myomectomy may result in fewer adhesions than abdominal myomectomy (laparotomy).
- Childbirth complications. A myomectomy can increase certain risks during 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 (C-section) to avoid rupture of the uterus during labor, a very rare complication of pregnancy.
- Rare chance of hysterectomy. Rarely, the surgeon must remove the uterus if bleeding is uncontrollable or other abnormalities are found in addition to fibroids.
Strategies to prevent possible surgical complications
To minimize risks of myomectomy surgery, your doctor may recommend:
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- Iron supplements. If you have iron deficiency anemia from heavy menstrual periods, your doctor might recommend iron supplements to allow you to build up your blood count before 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.
- 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 after you stop taking the medication. Treatment generally occurs over several months before surgery.
Evidence suggests that not every woman should take Gn-RH agonist therapy before myomectomy. Gn-RH agonist therapy may soften and shrink fibroids enough to interfere with their detection and removal. Cost of the medication and the risk of side effects must be weighed against the benefits.
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Gynecology. ACOG Practice Bulletin No. 96. Alternatives to hysterectomy in the management of leiomyomas. Obstetrics and Gynecology. 2008;112:387.
- Laughlin SK, et al. Uterine leiomyomas: Individualizing the approach to a heterogenous condition. Obstetrics and Gynecology. 2011;117:396.
- Frequently asked questions. Gynecologic problems FAQ074. Uterine fibroids. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq074.pdf?dmc=1&ts=20130423T1546469165. Accessed April 23, 2013.
- Parker WH. Abdominal myomectomy. http://www.uptodate.com/home. Accessed April 23, 2013.
- Parker WH. Laparoscopic myomectomy and other laparoscopic treatments for uterine leiomyomas (fibroids). http://www.uptodate.com/home. Accessed April 23, 2013.
- Bradley LD. Hysteroscopic myomectomy. http://www.uptodate.com/home. Accessed April 23, 2013.
- Brady PC, et al. Uterine fibroids and subfertility: An update on the role of myomectomy. Current Opinion on Obstetrics and Gynecology. In press. Accessed April 23, 2013.
- Parker WH. Techniques to reduce blood loss during abdominal or laparoscopic myomectomy. http://www.uptodate.com/home. Accessed April 23, 2013.
- Gallenberg MM (expert opinion). Mayo Clinic, Rochester, Minn. April 30, 2013.
- Stewart EA (expert opinion). Mayo Clinic, Rochester, Minn. April 29, 2013.
- Jensen JR (expert opinion). Mayo Clinic, Rochester, Minn. May 15, 2013.