Myomectomy (fibroids treatment)

Fibroids are benign (non-cancerous) growths of uterine tissue, formed by a thickening of the lining of the uterus.

Fibroids are common, with approximately one in three women developing a fibroid within their lifetime. They can be more common in women of child-bearing age who do not have children. Some ethnic groups such as Afro-Caribbean women can be more prone to developing fibroids, too.

These growths tend to be oestrogen-dependent, which means they can grow during pregnancy or shrink after the menopause due to hormonal changes.

Miss Sucheta Iyengar is a consultant gynaecologist with Circle Health Group, working at The Chiltern Hospital. She has reassuring news for anyone diagnosed with a myoma/fibroid:

"A myoma is benign. Just because there is a fibroid, it doesn't mean that it needs treatment."

This is especially true if your symptoms aren't interfering with your day-to-day life. Some women may not have any adverse symptoms and will be otherwise unaware of their fibroids.

The size of a fibroid can vary greatly, ranging from roughly 1cm to 20cm. You may have lots of little fibroids, or one larger fibroid, and either of these would not be considered out of the ordinary.

The location of the fibroids is something your consultant will wish to consider when looking at potential treatment. They can be found:

• Protruding into the lining of the uterus
• Just in the wall of the uterus
• Outside the wall of the uterus

Symptoms of fibroids can be varied, and will typically depend on their size, how many there are, and where they are located. Miss Iyengar explains that common symptoms can include:

• Swelling in lower abdomen
• A feeling of pressure in the uterus
• Needing to urinate more frequently than usual
• Back ache
• Constipation
• Heavy and/or painful periods (due to the fibroid stopping the uterus contracting efficiently during a period)
• Vaginal bleeding after sex
• Irregular bleeding in between periods

Much like the variety of symptoms experienced, any treatment plan will be guided by how many fibroids you have, how big they are, and where they are located.

If you have been diagnosed as having a fibroid or fibroids, there are many treatment options at your disposal. The suitability of each of these will be outlined by your consultant when it comes to discussing treatment plans.

The primary reason for a myomectomy would be when fibroid removal is necessary to preserve fertility. Miss Iyengar explains:

"For most women with one or two little fibroids, they don't need a myomectomy. There are lots of different treatment options. The only time we will do a myomectomy is when they want to preserve fertility. If a woman wants to have a baby and she is getting a lot of symptoms, then a lot of the other options are not suitable."

So, a myomectomy will be recommended if it's thought that your fibroids are affecting - or could affect - your fertility. The other reason we might recommend a myomectomy would be if your symptoms caused by fibroids are significantly impacting your life.

A hysterectomy (where the uterus is removed) is considered to be highly effective in ensuring fibroids don't return. However, a hysterectomy comes with significant permanent side effects: you'll no longer be able to get pregnant, and it will bring on early menopause. This procedure is commonly used for fibroid removal for women who no longer wish to have children and/or have gone through the menopause already.

If you are still hoping to have children in the future, but your symptoms are significantly affecting your daily routine, a myomectomy may be recommended.

Occasionally, excessive bleeding during the myomectomy will result in the need for a hysterectomy, but these risks will be fully outlined during your consultation.

When you meet with your Circle Health Group consultant, they will carry out a thorough assessment of your condition and talk through suitable treatment options.

Your consultant will begin by taking a detailed medical history and will ask some specific questions to get to know the issues you've been facing. If fibroids are already confirmed or suspected, these questions may include:

• Do you have any lower abdominal discomfort or swelling?
• Do you feel pregnant?
• Are the fibroids affecting your bowel and/or bladder function because of pressure symptoms?
• Are you going to the toilet frequently?
• Are they making you constipated and/or are you having difficulties opening your bowels as a result?
• Is your menstrual cycle being affected? (You may find that your periods are very heavy and painful. You may also experience irregular bleeding between your periods, without the natural break)

You may have been referred to Circle Health Group by your GP, and you may already be in the possession of diagnostic scans, but the primary goal at this stage is to find you an accurate diagnosis. This may involve having some additional tests, scans, or procedures.

An ultrasound scan is the go-to diagnostic tool used to confirm the presence of fibroids.

Occasionally an MRI scan may also be used to check there is nothing else of concern going on (such as adenomyosis, an enlargement of the uterus due to displaced tissue growing into the wall of the uterus, which shares similar symptoms and can be mistaken for fibroids).

What happens after your diagnosis

Once the presence of fibroids has been confirmed, along with the size, location and number of fibroids, your consultant will discuss all your treatment options with you. These will range from non-invasive measures to surgical procedures, depending on your desired outcome, the significance of your symptoms, and the nature of your fibroids.

Factors to take into consideration include:

• Whether or not you wish to get pregnant in future
• Your age and how close you are to menopause
• Do you have noticeable symptoms?
• The size, number, and location of the fibroids

There are two approaches to performing myomectomies: open myomectomy and laparoscopic myomectomy (keyhole surgery).

Open surgery for fibroids

A myomectomy is typically performed as an open abdominal operation under general anaesthetic, with one large incision made, either across the bikini line or in a vertical line down the abdomen. Depending on the size or number of fibroids, another incision may be made if necessary.

Once the incision has been made and access to the uterus has been established, any fibroids will be surgically removed. Sometimes a drug will be injected into the fibroid in order to help prevent excessive blood loss, or a tourniquet will be used on the fibroid to cut off the blood supply. With the fibroids removed, your incision will be closed and stitched/stapled together to complete the operation.

Laparoscopic myomectomies

In some instances you might be offered a laparoscopic (keyhole) myomectomy, which is where your surgeon inserts specially designed tools through very small incisions to perform the operation without 'opening you up'.

A laparoscopic myomectomy might have a shorter recovery time than an open myomectomy, but this type of surgery won't be the best choice for everyone, so you should speak to your consultant about whether it's the right treatment for you.

Both a laparoscopic and hysteroscopic myomectomy carry their own risks, which your consultant would be able to discuss in greater detail with you if appropriate.

As we've mentioned above, there are a number of treatment options for fibroids, which range from non-invasive measures to surgical procedures, depending your symptoms and a few different factors.

Medication

If excessive bleeding is one of your primary symptoms, medical treatment can be effective, such as the use of hormonal contraception. Other medication can help shrink the fibroids and prevent further bleeding, used in an on-off cyclical program, as determined by the type of medication itself.

Uterine artery embolisation (UAE)

Uterine artery embolisation is a minimally-invasive procedure that uses X-ray image guidance to send a catheter through an incision in your groin up the femoral artery towards the uterus.

Once it reaches the blood vessels supplying your fibroids, particles of gelatin sponge or tiny plastic are used to block the blood vessels, causing the fibroids to shrink.

Although the fibroids will remain, this can help reduce pain and other symptoms, especially if you've been concerned with any swelling, bloating, or pressure-related symptoms.

Hysterectomy

Occasionally, a hysterectomy may be the most suitable option for recovery. This is a major operation involving the removal of the uterus, leaving no risk of fibroids reoccurring. You will not be able to get pregnant afterwards, so this procedure is unsuitable for those who wish to continue their family.

Hysterectomies can be performed in a number of ways, depending on the nature of your symptoms, including:

• Total hysterectomy - removal of the uterus and cervix
• Subtotal hysterectomy - removal of the uterus, leaving the cervix intact
• Radical hysterectomy - removal of the uterus, ovaries, fallopian tubes, cervix, and the top section of the vagina

The way this operation is undertaken will depend on various factors, but it can be offered either laparoscopically (laparoscopic or 'keyhole' hysterectomy), through the vagina (vaginal hysterectomy), or through an incision in the abdomen (abdominal hysterectomy).

As myomectomies are a major form of surgery and are typically performed under general anaesthetic, you should be prepared to stay with us for a few days, where a team of nurses will be on hand to provide post-operative care.

A catheter will be put in place while you recover from surgery, as you won't be able to get up to use the toilet at first. This is because a spinal injection is often used alongside the general anaesthetic to help combat pain experienced in the aftermath of the operation. The catheter is normally removed the following day, and the nurses will be able to help you start getting up and walking again.

You will be able to leave the hospital and go home once you can pass urine yourself, your pain is under control, and you are eating and drinking again, all of which normally takes a few days.

It can take between six and eight weeks before you will be ready to return to work, depending on the nature of your job. This is also the timescale for a follow-up appointment, where your consultant will review the progress of your recovery. Your consultant might recommend that you don't lift anything heavy for 12 weeks while your body recovers from the surgery.

In terms of timescales for a return to driving, you will probably need to wait at least four weeks. It's best to ask your consultant and also speak to your insurance company just to be safe.

Below, we answer some frequently asked questions about myomectomy.

What is a myomectomy?

A myomectomy is an operation where your surgeon will go inside your abdomen and remove any fibroids, leaving the uterus, ovaries and cervix intact.

How long does the operation take?

The length of time your myomectomy will take will depend entirely on the size and number of fibroids you are having removed, but it can take several hours. Your consultant will be able to advise an expected timeframe once all diagnostics have been undertaken and the relevant information ascertained.

How long will my recovery be?

You will normally spend a few days in our hospital after surgery while you recover from the general anaesthetic and our nursing team checks on your wound.

You will be able to drive again after 4 weeks, and it will typically take 6-8 weeks before you can return to work. Patients should wait 12 weeks before any heavy lifting is attempted.

When you choose to go private with Circle, you'll benefit from:

Fast access

When you chose Circle Health Group for your private healthcare, you will get rapid access to a consultant. Private consultations at Circle Health Group are typically available six days a week, with some weekday evening access, ensuring appointment times to suit your schedule.

With demands on healthcare increasing and many people experiencing long waiting lists for help, we can help you get the treatment you need quickly.

Flexible appointments

Private consultations can be booked on a day that is convenient for you, and you can choose the consultant you see. This is helpful if you have been recommended a consultant by a friend or family member or have seen a particular consultant previously.

Consultant-led care

You will only ever see a Consultant Gynaecologist at a private consultation with us. By ensuring a streamlined process from assessment to diagnosis and through to treatment, we can help get your fibroids treated and any symptoms resolved at the earliest possible stage.

When you are struggling with pelvic pain, irregular bleeding or any other problem that is causing you concern, it is sensible to see a specialist for assessment, diagnosis and treatment advice.

If you need a myomectomy to remove uterine fibroids, our specialist team of consultant gynaecologists are here to help.

You can book a private consultation online at your local Circle Health Group hospital, or speak to a member of the team on 0141 300 5009.

Content reviewed by Circle in-house team in August 2022. Next review due August 2025.