If you are a woman who is dealing with uterine fibroids, you may be wondering if you need a myomectomy or a hysterectomy. Uterine fibroids are benign tumors that grow in, on, or within the walls of the uterus. Both myomectomies and hysterectomies are designed to remove tumors like fibroids from the uterus, but they are performed in different ways and have different benefits and risks. In this blog post, we will compare a myomectomy with a hysterectomy and help you decide which procedure is right for you.
What is a myomectomy?
A myomectomy is a surgical procedure to remove uterine fibroids. Fibroids are non-cancerous growths that can develop in the uterus. When the size and number of fibroids allow, myomectomy is often performed using laparoscopic surgery, which is a minimally invasive surgery. This means that the surgeon makes small incisions in the abdomen and inserts a small camera to guide the surgery. However, there are different surgical approaches that can be used to complete a myomectomy including: hysteroscopic myomectomy, robotic-assisted myomectomy, and abdominal myomectomy.
Each approach varies slightly in terms of what to expect during and after the surgery. Generally speaking a hysteroscopic approach requires no hospital stay and 1-4 days of recovery at home, a laparoscopic or robotic approach requires one night in the hospital and a 4 week recovery at home, and an abdominal approach requires a few days in the hospital and a recovery period of up to 6 weeks.
Benefits of a Myomectomy
- Myomectomy is less invasive than hysterectomy, so it has a shorter recovery time.
- Myomectomy preserves the uterus, so it is an option for women who want to have children in the future.
Drawbacks of a Myomectomy
- Fibroids may recur and require additional procedures
- May not be recommended depending on location, size, and number of fibroids
What is a hysterectomy?
A hysterectomy is a surgical procedure to remove the uterus. Hysterectomy can be performed using different surgical approaches such as a vaginal hysterectomy, laparoscopy-assisted vaginal hysterectomy (LAVH), robotic-assisted laparoscopic hysterectomy, or abdominal hysterectomy (open surgery). When deciding on a surgical approach, the least invasive options are preferential. Out of all the surgical approaches, open surgery is a more invasive procedure, so it has a longer recovery time and is only used if necessary. However, open surgery may be necessary in some cases, such as if the fibroids are very large or if other approaches are simply not sufficient. Hysterectomy permanently removes the uterus, so it is not an option for women who want to have children in the future. In some cases, the ovaries may also be removed.
Benefits of a Hysterectomy
- Permanently removes the uterus, so there is no chance of fibroids recurring
- May be recommended if other treatments have failed
Drawbacks of a Hysterectomy
- May be linked to longer-term effects in some women, such as a higher chance of urinary incontinence later in life and an earlier menopause, even when the ovaries are kept. Hysterectomy at a younger age (especially 35 or younger) has also been associated with a higher long-term risk of heart disease.
- Recovery time is longer than a myomectomy
So, which procedure is right for you?
The best way to determine if you need a myomectomy or hysterectomy is to talk to your doctor. They will be able to recommend the best treatment option for you based on the size, location, and number of fibroids as well as your overall health. It is important to note that both procedures carry the risks associated with surgery and general anesthesia, so you will consider these risks as well during your decision making process. In many cases, your doctor may also recommend a nonsurgical option such as uterine fibroid embolization (UFE, also called uterine artery embolization), a minimally invasive procedure performed by an interventional radiologist that treats fibroids while preserving the uterus.
If you are considering a myomectomy, you should talk to your doctor about the risks and benefits of the procedure. Myomectomy is less invasive than hysterectomy, so it has a shorter recovery time. Additionally, myomectomy preserves the uterus, so it is an option for women who want to have children in the future. If fibroids distort the inside of the uterus, removing them may improve the chances of conceiving, although the evidence for other types of fibroids is uncertain. However, myomectomy may not be an option if your fibroids are very large.
If you are considering a hysterectomy, you should talk to your doctor about the risks and benefits of the procedure. Hysterectomy is a more invasive surgery, so it has a longer recovery time. However, hysterectomy permanently removes the uterus and fibroids. This can be an ideal option for someone who wants to permanently eliminate their fibroids, but it is not an option for women who want to have children in the future.
If you are dealing with uterine fibroids, talk to your doctor about your options. Myomectomy and hysterectomy are both effective surgical treatments for uterine fibroids, and uterine fibroid embolization (UFE) is an effective nonsurgical alternative for many women. 1Fibroid does not perform myomectomy or hysterectomy: we treat fibroids with UFE and refer patients who need surgery to experienced gynecologic surgeons. The best treatment for you will ultimately depend on your individual medical history and health condition.
Sources
- Management of Symptomatic Uterine Leiomyomas. American College of Obstetricians and Gynecologists (Practice Bulletin No. 228), 2021.
- Choosing the Route of Hysterectomy for Benign Disease. American College of Obstetricians and Gynecologists (Committee Opinion No. 701), 2017.
- Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev, 2020.
- Uterine artery embolisation versus myomectomy for premenopausal women with uterine fibroids wishing to avoid hysterectomy: the FEMME RCT. Health Technol Assess, 2022.
- Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study. Menopause, 2018.
- The association of hysterectomy and menopause: a prospective cohort study. BJOG, 2005.
- Hysterectomy and urinary incontinence: a systematic review. Lancet, 2000.
- Uterine fibroids and uterine fibroid embolization (UFE) treatment. Society of Interventional Radiology.