Myomectomy

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What is Myomectomy?
Myomectomy is a surgical procedure to remove uterine fibroids — noncancerous growths that often appear in your uterus during your childbearing years. The surgeon's goal during myomectomy is to take out symptom-causing fibroids and reconstruct the uterus. Unlike hysterectomy, which removes your entire uterus, myomectomy surgery removes only the fibroids and leaves your uterus intact.

Women who undergo myomectomy report improvement in fibroid symptoms, including heavy menstrual bleeding and pelvic pressure. In the hands of an experienced surgeon, myomectomy is safe and effective.

Why it is done?
Your doctor might recommend myomectomy for troublesome fibroids — that is, those in which symptoms are debilitating or interfere with your normal activities — if:

* You plan to bear children
* Your doctor suspects uterine fibroids might be interfering with your fertility * You prefer to retain your uterus

Risks

Myomectomy has a low complication rate. Still, the procedure poses a unique set of challenges for your surgeon.

Risks of myomectomy include:

* Excessive blood loss. The uterus has a rich network of blood vessels, and fibroids stimulate growth of new vessels to obtain their own blood supply. So during myomectomy, surgeons must take extra steps to avoid excessive bleeding. These steps include blocking flow from the uterine arteries and injecting medications around fibroids to cause blood vessels to clamp down. Your doctor may also suggest steps to take to build up your blood count before surgery. * Scar tissue. Incisions into the uterus to remove fibroids can lead to adhesions — bands of scar tissue that may develop after surgery. Within the uterus, adhesions may block implantation of a fertilized egg in the uterine lining, but this rarely happens. Outside the uterus, adhesions could entangle neighboring structures and lead to a blocked fallopian tube or a trapped loop of intestine. * Development of new fibroids. Myomectomy doesn't eliminate your risk of developing more fibroids later. Tiny tumors (seedlings) that your doctor doesn't detect during surgery could eventually grow and cause symptoms. New tumors also can develop. Women who had only one fibroid have a lower recurrence rate than do women with multiple fibroids. If fibroids return, future treatment — a repeat myomectomy, hysterectomy or other procedure — may be necessary. * Childbirth complications. Having had myomectomy surgery can pose some risk factors for delivery if you become pregnant. If your surgeon had to make a deep incision in your uterine wall, the doctor who manages your subsequent pregnancy may recommend cesarean delivery to avoid rupture of the uterus during labor. * Inability to restore the structure of the uterus. To remove embedded fibroids, the surgeon might cut into the muscular wall (myometrium), leaving a gap. Closing it requires stitches, usually in layers. Rarely, the surgeon must remove the uterus if bleeding is severe or if he or she can't reconstruct the uterus.

Strategies to prevent possible surgical complications
To minimize risks of myomectomy surgery, your doctor may recommend:

* Iron supplements and multivitamins. If you have iron deficiency anemia from heavy menstrual periods, your doctor might recommend iron supplements and multivitamins to allow you to build up your blood count prior to surgery. * Hormonal treatment. Another strategy to correct anemia is hormonal treatment before surgery. Your doctor may prescribe a gonadotropin-releasing hormone (Gn-RH) agonist, birth control pills, or other hormonal medication to stop or decrease your menstrual flow. When given as therapy, a Gn-RH agonist blocks the production of estrogen and progesterone, stopping menstruation and allowing you to rebuild hemoglobin and iron stores. * Therapy to shrink fibroids. Some hormonal therapies, such as Gn-RH agonist therapy, can also shrink your fibroids and uterus enough to...
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