Myomectomy: Purpose, Procedure, Risks, Results and Recovery

What is a myomectomy surgery?

A myomectomy is a fertility-preserving surgery where we remove uterine fibroids (leiomyomas) and rebuild the uterus, keeping the uterus and ovaries in place. The goal is twofold: (1) relieve symptoms like heavy bleeding, pelvic pressure, pain, urinary frequency or infertility, and (2) preserve your ability to conceive and carry a pregnancy in the future.

What exactly happens in a myomectomy?

• Mapping the fibroids: We first define the number, size and location of fibroids using ultrasound (and MRI when needed). This tells us which approach—hysteroscopic, laparoscopic/robotic or open (abdominal)—is safest and most effective for you.
• Precision removal: During surgery, we make targeted incisions on the uterus, separate fibroids from the surrounding muscle, and remove them without removing the uterus.
• Layered uterine repair: We then stitch the uterine wall in multiple layers to restore strength and reduce bleeding—this meticulous repair is crucial for future pregnancy safety.
• Recovery focus: Pain control, early mobilization, and careful follow-up help you recover smoothly and reduce the chance of complications like clots or infection.

Why Choose Myomectomy? (Purpose & Indications)

Fibroids are benign growths in or around the uterus. Many never cause symptoms, but in some women they lead to:

• Heavy menstrual bleeding (often causing anemia)
• Pain, pressure or dragging sensation in the pelvis
• Frequent urination (bladder pressure) or difficulty emptying bowel
• Infertility or recurrent pregnancy loss
• Enlargement of the abdomen (bulk symptoms)

When symptoms affect daily life or fertility, and less invasive treatments (medications, hormonal therapy, uterine artery embolization) are inadequate or unsuitable, myomectomy is considered. Because the uterus remains intact, myomectomy is preferred when preserving fertility or menstrual function is a goal.

Types of Myomectomy (Surgical Methods) 

The choice of technique depends on size, number, and location of fibroids, as well as surgeon’s expertise and available resources. Broadly, the methods are:

Dr. Muley often assesses each case individually to choose the optimal approach, balancing safety and fertility preservation.

What Happens Before Surgery? (Preparation)

Before surgery, Dr. Muley and his team will:

1. Evaluate thoroughly

• Imaging: ultrasound (2D/3D) and possibly MRI to map fibroid positions
• Blood tests: full blood count, coagulation profile
• Anemia correction (iron, B12) if needed
• Pre-anesthetic evaluation to rule out risks

2. Medical optimization

• Some patients are given hormone therapy (like GnRH analogues) short-term to shrink fibroids and reduce bleeding
• Stop certain medications (e.g. blood thinners) as per anesthetist’s instructions
• Bowel preparation if needed (based on approach)

3. Patient counseling & consent

• Explaining the procedure, risks, benefits, and recovery timeline
• Discussing fertility planning and future pregnancy monitoring
• Instructions on fasting (nil per oral) before surgery

4. Logistics & support

• Ensure help at home post-discharge
• Plan for time off work and rest

Step-by-Step: How Myomectomy Is Performed

While details vary by approach, here is a general outline:

1. Anesthesia & access

• General anesthesia is typically used
• For open surgery: incision in lower abdomen
• For laparoscopy/robot: several small ports plus camera

2. Locating & dissecting fibroids

• The uterus is carefully examined
• Surgeon makes incisions over the fibroids in the uterine muscle
• Fibroids are dissected out, trying to minimize damage to surrounding tissue

3. Hemostasis & uterine repair

• Bleeding is carefully controlled (ligation, electrocautery, sutures)
• The uterine wall is meticulously sutured in layers to restore strength

4. Remove fibroid tissue

• In laparoscopy, large fibroids are removed via morcellation (fragmentation) or via mini-incision
• In open surgery, directly removed through the incision

5. Closure & finishing

• Irrigation and check for bleeding
• Placement of drains if needed
• Closure of abdominal wall layers

Duration can vary, but most surgeries take 2 to 3 hours, sometimes more in complex cases.

Risks & Complications

Every surgery has potential risks. With myomectomy, possible complications include:

• Bleeding (intraoperative or postoperative)
• Need for blood transfusion
• Infection (wound, pelvic)
• Injury to adjacent organs (bladder, bowel, ureters)
• Adhesions (scar tissue inside the pelvis)
• Conversion (in minimally invasive surgery) to open procedure
• Uterine rupture in future pregnancy (rare, but higher risk)
• Recurrence of fibroids (new ones may grow later)

Dr. Muley approach emphasizes minimizing risks through careful planning, surgical technique, and postoperative monitoring.

Recovery & Results

Immediately After Surgery

• You’ll go to a recovery room where vitals are monitored
• IV fluids, pain management, and antibiotics as needed
• A catheter may remain until you can urinate freely
• Drains (if used) are removed based on output

Hospital Stay

• Open surgery: Typically 2–4 days
• Laparoscopic / robotic: Often 1–2 days

At Home Recovery

• Mild pain, discomfort is expected; managed with analgesics
• Gradually increase mobility (walking) to reduce clot risk
• Avoid strenuous activities and heavy lifting (≥ 5–10 kg) for 4–6 weeks
• No sexual intercourse until cleared (often ~6 weeks)

Return to Normal Life 

• Laparoscopic cases: Many return to normal routines in 2–4 weeks
• Open surgery: Full recovery may take ~6 weeks or more

Fertility & Pregnancy After Myomectomy

• Many women conceive after the surgery
• It is generally advised to wait 3–6 months before attempting pregnancy, to allow uterine healing
• Pregnancy is monitored more closely, and often a cesarean (C-section) delivery is planned to avoid stress on the uterine scar
• Some women may still have lighter, more regular menstrual cycles post-surgery

Fibroid Recurrence

• New fibroids can arise over time, particularly in younger women (< 40) and those with multiple fibroids
• Lifelong follow-up with imaging is often recommended

Why Trust Dr. Pradeep Muley & Fortis Delhi?

• Experience & specialization: Under his care, patients receive individualized plans balancing safety and fertility.
• Access to advanced technology: The hospital is equipped for laparoscopic, robotic, and open surgeries, enabling choice based on patient needs.
• Patient-first philosophy: Detailed counselling, clear communication, and supportive postoperative care.
• Indian context, global standards: Outcomes benchmarked with international guidelines, adapted to Indian patient realities.

FAQs

Will I lose my uterus after myomectomy?

No — that is the strength of this procedure. Only fibroids are removed; uterus remains intact.

Does my period change after surgery?

Often yes. Many women report lighter, more regular menstruation.

Can I deliver vaginally later?

Sometimes yes, but obstetricians often prefer cesarean delivery depending on scar and fibroid location.

Is there scarring?

Yes — open surgery leaves an abdominal scar (usually in bikini line); laparoscopic/robotic leave small scars; hysteroscopic leaves no external scars.

Can fibroids grow back?

Yes, new fibroids may develop over time, which underscores the importance of monitoring.

Final Thoughts

Myomectomy offers a powerful option to relieve fibroid symptoms while preserving fertility and the uterus. With proper planning, surgical technique, and follow-up care, the risks can be minimized and outcomes can be excellent.

If you or someone you know is exploring fibroid surgery in Delhi or nearby, feel free to reach out to my clinic at Fortis Hospital. I’m happy to guide you through the process, answer your questions, and tailor treatment to your individual circumstances.