Statistics show that over 80% of all women will experience uterine fibroids before age 55. For a number of women, fibroids do not cause any symptoms, but for others, they can produce abdominal/pelvic pain, severe bleeding, anemia, increased urinary frequency, and significantly interfere with their lives.
Most OB/GYNs recommend medical therapy (e.g. ibuprofen/tranexamic acid, birth control pills, progestin-containing IUD) which is a temporary fix at best. Once this fails, surgery is typically the next option recommended. The surgery comes in one of two options: the surgical removal of some of the fibroids through a myomectomy or a hysterectomy with surgical removal of the uterus.
A hysterectomy removes the possibility of having children, so women who desire to preserve their fertility can feel like they have no other option. Although a myomectomy can relieve the symptoms of uterine fibroids in the short term, most women do not understand that myomectomy rarely removes all of the fibroids and therefore the recurrence rate of myomectomy is very high (11% per year!). Today we are talking about common and lesser-known side effects of myomectomy surgery.
Different Types of Myomectomies
1. Hysteroscopic Myomectomy
This procedure can only be used to address fibroids type 0 or 1 by FIGO classification (see the picture below) that are completely within the uterine cavity or predominantly in the cavity which are rarely the only fibroids present. In addition, there is a size limit to what can be safely removed by this approach.
Fibroids need to be less than 3.5 cm (< 11/2 inches) which is roughly the size of a small strawberry. Therefore, hysteroscopic myomectomies are the least type of myomectomy performed and patients typically need a procedure that addresses all types and sizes of fibroids (i.e. uterine fibroid embolization) and not just small ones in the uterine cavity.
To perform a hysteroscopic myomectomy, the surgeon uses a small surgical instrument that is inserted into the vagina and through the cervix to access and remove the fibroids. There is a rapid installation of fluid to distend the uterine cavity which allows the surgeon to see the intracavitary fibroid. This fluid balance needs to be very carefully monitored to avoid serious complications (even death) during the procedure.
The fibroid(s) is usually removed using a tool called a wire loop resectoscope that removes the fibroid with an electrically charged wire loop or a hysteroscopic morcellator that manually cuts the fibroid with a blade. The recovery time is normally a few days.
Hysteroscopic Myomectomy Side Effects
- Reactions to general anesthesia;
- Cervical abrasions or other damage;
- Uterine perforation;
- Inability to completely remove the fibroid with one surgery;
- Development of scar tissue inside the uterine cavity that could cause fertility issues;
- Intestinal or bladder injury;
Uncommon but very serious side effects of hysteroscopy include:
- Fluid intravasation (an overload of pressurized fluid entering the blood vessels);
- Pregnancy-related uterine rupture or abnormal placentation;
- Gas embolism – gas bubbles introduced to the bloodstream (randomized trials showed frequent instances during hysteroscopic fibroid removal).
2. Laparoscopic Myomectomy
A laparoscopic myomectomy is performed through several small abdominal incisions with the use of a laparoscope – a long thin surgical tube that has a light and camera on the end and is placed through a larger metal straw. The surgeon uses tiny tools inserted through the metal straws placed in the abdomen and removes the fibroids after they have been chopped up with a device called a morcellator while being guided by a video projected onto a nearby screen by the laparoscopic camera.
The surgeon can remove fibroids that are easily accessible in the uterus but often cannot remove all of the fibroids within the muscular walls of the uterus. Another version of a laparoscopic myomectomy is done using robotic arms controlling the instruments rather than the surgeon’s hands themselves.
The surgeon controls these robotic arms instead of doing the procedure manually. While this can sometimes offer more precise movements, this added dexterity is rarely needed. It also extends the length of the surgery and is more expensive for the patient. The recovery time is typically between 4 and 6 weeks regardless of who holds the laparoscopic instruments.
Side Effects After Laparoscopic Myomectomy
According to recent studies, complications after laparoscopic myomectomies have increased in the last decade. Some of the reasons may include:
- Women are waiting longer to have children and seek treatment for infertility due to fibroids;
- Large or numerous myomas are more common in women in their late child-bearing years;
- And the most concerning of all the reasons mentioned in this study was the increased use of robotic procedures and the significant learning curve necessary to perform and maintain proficiency in these procedures. Hospital administrators often place undue pressure on physicians to use this very expensive robotic equipment even in situations where the added expense provides no additional value and perhaps even added risk to the patient.
- Complications from general anesthesia (this may be increased during robotic surgery due to the extended surgery time);
- Excessive blood loss (especially dangerous for women with anemia);
- Uterine injury/perforation;
- Damage to neighboring organs (e.g. bladder, bowel);
- Formation of uterine adhesions (scar tissue);
- Blood clots;
- Conversion to hysterectomy (if there is too much blood loss during surgery or if there is difficulty in reconstructing the defects in the uterus caused by fibroid removal a hysterectomy is performed instead);
- Possibility of spreading unsuspected cancer.
3. Open Myomectomy
An abdominal myomectomy is often called an “open” myomectomy and is the most invasive myomectomy technique. The surgeon makes an incision in the lower abdomen, similar to a C-section (i.e. horizontal long incision between the hips), and cuts out the fibroids one at a time.
In some cases, a vertical incision may also be made if the fibroids are located above the belly button and are difficult to reach by pulling up the skin created by the long, horizontal incision. This major surgical procedure requires layers of sutures and has a recovery time of about 8 weeks.
Abdominal Myomectomy Side Effects
Open myomectomy is associated with risks and complications that are very similar to other types of myomectomy and include:
- Significant blood loss resulting in blood transfusion;
- Uterine trauma and weakness of the uterine muscle that is operated on;
- Uterine scarring (adhesions);
- Deep vein thrombosis/pulmonary embolus;
- Conversion to hysterectomy.
Recovering from a myomectomy takes between 6 to 8 weeks depending on the technique used. While your uterus is healing after a myomectomy, you need to follow all the post-operative instructions provided to you by the surgeon.
It is normal to have Irregular periods after a myomectomy for at least a few cycles. Some women have even reported no period for a few months after a myomectomy, while others have reported the early onset of menopause after undergoing a myomectomy.
Myomectomy Alternative – UFE
Regardless of the procedure technique used to remove fibroids during a myomectomy, patients may experience complications related to the surgery.
However, there is an outstanding treatment alternative that allows women to completely avoid the significant risks and long recovery of surgery, while at the same time receiving the relief of symptoms that they desire. This nonsurgical, outpatient procedure is called Uterine Fibroid Embolization or UFE and when performed by an Interventional Radiologist who is expertly skilled in the procedure can eliminate fibroids no matter where they are located, how numerous they are, and regardless of their size.
UFE treats fibroids by cutting off their blood supply which causes them to shrink and die. It is done as an outpatient procedure so there is no hospital stay involved. Patients after UFE have even had children.
The births that have occurred after UFE at the renowned Atlanta Fibroid Center have typically been full-term and vaginal. This is in marked contradistinction to those babies born after myomectomy which mandate a c-section due to concern over uterine wall weakness and potential rupture from the surgical myomectomy site.
The recovery time for UFE is only 5-7 days compared to the 6-8 weeks of recovery following surgical myomectomy. UFE patients return home the same day of the procedure with only a bandaid versus an inpatient hospital stay of a few days with a myomectomy.
Contact The Atlanta Fibroid Center to learn more about UFE and how it can help you become fibroid free without the risks and complications of myomectomy surgery.