Myomectomy

What you should know

• Myomectomy surgery removes one or more myomas from your uterus (womb). Myomas are also called fibroid tumors (growths of tissue and muscle) or leiomyomas. A woman's uterus is the organ where a fetus (unborn baby) grows during pregnancy. Myomas may cause more bleeding than usual during or between your monthly periods. Your periods also may last longer if you have myomas. If you bleed too much, you may get anemia (a condition where your blood does not have enough iron). Myomas can cause pain and pressure in your lower abdomen, and you may need to urinate more often. Myomas may make it harder to get pregnant or may cause problems during pregnancy. Myomas are usually benign, which means they do not have cancer in them.
  
  
• Myomas are removed using open or laparoscopic surgery. During an open myomectomy, your caregiver will make an incision (cut) into your abdomen to remove your myomas. If you are having laparoscopic surgery, your caregiver will remove the myomas through smaller cuts in your abdomen. After a myomectomy, you may bleed less during or between your periods. You may have less pain in your abdomen. It may be easier for you to get pregnant and to carry your baby full-term.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• During surgery, your caregiver may switch to an open myomectomy if your myomas cannot be removed through smaller cuts. You may get an infection in your wound (surgery area). Your bowel, blood vessels, or uterus may be damaged. You may bleed too much and need a blood transfusion or a hysterectomy (surgery to remove your uterus). If you have a hysterectomy, you cannot get pregnant. After surgery, you may have trouble urinating or having a bowel movement (BM). You may get fibroids again. You may have scar tissue that causes pain or makes it harder for you to get pregnant. You may have heart problems and you may die.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• Without surgery, your myomas may grow bigger. Large myomas can cause pain and pressure in your abdomen and you may have trouble breathing. You may bleed too much from your vagina and get anemia. It may be harder to get pregnant. If you become pregnant, then you may have a miscarriage (lose your baby) or have your baby too early. Talk to your caregiver if you have questions or concerns about your myomectomy, myomas, or care.

Getting Ready

Before your surgery:

• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• Your caregiver will do a pelvic exam to feel your myomas. Your caregiver will put gloved fingers into your vagina and press down on your abdomen with the other hand.
  
  
• Your caregiver may need to take a sample of your blood. Your caregiver may use a tool called a hysteroscope to look into your uterus. He may use this scope to take tissue from your uterus to send to a lab for testing. You may have an ultrasound or magnetic resonance imaging (MRI) to help show the size and location of your myomas. Ask your caregiver for more information about the tests that you need. Write down the date, time, and location of each test.
  
  
• Certain hormones (chemicals) may cause myomas to grow in your uterus. Your caregiver may give you medicine to decrease these hormones and shrink your myomas. If you have anemia, your caregiver may give you iron pills. Ask your caregiver for more information about medicines you may take before your myomectomy.
  
  
• Tell your caregiver if you know or think you might be pregnant.
  
  
• You may need a blood transfusion if you lose a large amount of blood during surgery. Some people are worried about getting AIDS, hepatitis, or the West Nile virus from a blood transfusion. The risk of this happening is very low. Blood banks test all donated blood for AIDS, hepatitis, and the West Nile virus. You may be able to donate your own blood before surgery. This is called autologous blood donation. This must be done no later than three days before surgery. You may also ask a family member or friend with the same blood type to donate blood for you. This is called directed blood donation.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Ask your caregiver before you take any medicine on the day of your surgery. Bring a list of all the medicines you take, or your pill bottles, with you to the hospital. Caregivers will check that your medicines will not interact poorly with the medicine you need for surgery.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

Treatment

What will happen?

• You will be taken to the surgery room and moved to a table. You will be given general anesthesia, which will keep you asleep during the surgery. You may have an open or laparoscopic myomectomy. If you are having open myomectomy, your caregiver will make a cut across your abdomen. Your caregiver will open your uterus and locate the myomas. The myomas will be cut out of your uterus.
  
  
• With laparoscopic myomectomy, your caregiver will make smaller cuts on your abdomen. Your caregiver will put tools through these cuts to open your uterus and see the myomas. Your caregiver will cut the myomas into smaller pieces. The myomas will be removed through one of the smaller cuts or through a larger cut made on your abdomen. After open or laparoscopic myomectomy, your caregiver will stitch the cuts closed. Bandages will cover your wounds to keep them clean. The myomas may be sent to a lab to check for the cause of your fibroids.

After your surgery:

You will be taken to a room to rest until you are awake. Do not try to get out of bed until your caregiver says it is okay. After your caregiver sees that you are okay, you may go home. If you are staying in the hospital, you will be taken to your room.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You are late or cannot make it to your surgery on time.
  
  
• You feel new pressure in your abdomen.
  
  
• You have a fever.
  
  
• You have new pain in your abdomen, or your pain is getting worse.

Seek Care Immediately if

• You have bleeding from your vagina that does not stop.
  
  
• You have new trouble breathing.
  
  
• You suddenly have severe (very bad) stomach pain.