What is myomectomy, and when is it used?

Myomectomy is the surgical removal of fibroids while preserving the uterus - performed hysteroscopically (submucosal), laparoscopically, or by open (abdominal) surgery depending on size/location.

It is used in women who wish to preserve fertility or the uterus. Risks include bleeding, adhesions, a uterine scar (rupture risk in future pregnancy/labour), and fibroid recurrence.

Clinical relevance. Myomectomy preserves the uterus for women wanting fertility, but leaves a scar (rupture risk) and fibroids can recur.

More Detail

Myomectomy

Myomectomy removes fibroids while preserving the uterus, for women wanting fertility/uterine preservation.

What it is

• Surgical removal of fibroids, preserving the uterus.
• Routes:
  • Hysteroscopic - for submucosal/intracavitary fibroids.
  • Laparoscopic - for accessible subserosal/intramural fibroids.
  • Open (abdominal) - for large/multiple fibroids.

Indications

• Women who wish to preserve fertility or retain the uterus, with symptomatic fibroids.

Risks/considerations

• Bleeding (can be significant; GnRH agonists may be used pre-operatively).
• Adhesion formation.
• A uterine scar - risk of rupture in a future pregnancy/labour (a full-thickness myomectomy is an indication for caesarean).
• Fibroid recurrence.