Table of ContentsView AllTable of ContentsWhen Surgery Is NecessaryTypes of Fibroid SurgeryBenefits and DisadvantagesSurgical AlternativesFrequently Asked Questions:
Table of ContentsView All
View All
Table of Contents
When Surgery Is Necessary
Types of Fibroid Surgery
Benefits and Disadvantages
Surgical Alternatives
Frequently Asked Questions:
Uterine fibroids, also referred to as leiomyomas or myomas, are growths in the uterus or on the uterine wall. They vary in size from smaller than a pinhead to the size of a watermelon or bigger. The vast majority of uterine fibroids are benign (not cancerous).
While fibroids are often asymptomatic and do not require attention, symptoms are present in 20%–50% of cases and may require treatment.
Verywell / Danie Drinkwater
While surgery is an option for the treatment of fibroids, not everyone who needs or wants treatment for fibroids has to have surgery. Other less-invasive options are available.
This article discusses surgery options for uterine fibroids.
What Are Uterine Fibroids?
When determining treatment options and whether surgery is necessary, some important factors need to be considered, including:
The National Institute for Health and Care Excellence (NICE) recommends thathysterectomyshould be considered only when:
Amyomectomyis an option for surgery that retains fertility but may be considered too complex or risky if the fibroids are large or there are too many of them.
Purpose of Myomectomy
In cases of severe, life-threatening bleeding that is not responding to other treatments, an emergency hysterectomy may be the only option.
Hysterectomy, which is surgery to remove a woman’s uterus, is the only treatment option that guarantees full removal offibroidsand the symptoms that come with them. Hysterectomy guarantees they won’t return. It has a high success rate.
Myomectomyremoves the fibroids instead of shrinking them or destroying them. This procedure can be used as an alternative to hysterectomy for people who want to preserve their uterus. It can also be a more complicated surgery and carries a risk of fibroids returning.
Myomectomy
During a myomectomy, the fibroids are removed, but the uterus is left intact and repaired.
After amyomectomy, the uterus usually returns to functioning normally, including with regards to menstruation. Menstrual bleeding may be lighter than it was before surgery.
Pregnancy is possible after a myomectomy, but the pregnancy may need to be monitored for possible risks. Pregnancy outcomes will depend on how deep the fibroids were and if any spanned a large part of the uterine wall.
There are four main types of myomectomy.
Open Myomectomy
Open myomectomy, also known as abdominal myomectomy, is a procedure to remove subserosal fibroids (those attached to the outside wall of the uterus) or intramural fibroids (those embedded in the wall of the uterus.
This surgery is reserved for very large fibroids of 4 inches in diameter or larger or for when there are numerous fibroids, fibroids in an area of the uterus that’s difficult to access, or when cancer is suspected.
This surgery involves:
Standard Laparoscopic Myomectomy
Standard laparoscopic myomectomy is surgery that requires the insertion of a laparoscope (a small, lighted telescope) through the abdomen, near the navel. Several other small incisions are also required to allow special instruments to be inserted to remove the fibroids. Some surgeons also use a robotic machine to precisely control the movement of the instruments.
In this procedure, fibroids may also be removed through the vagina. Other facts to know about this procedure include that it is:
Single-Port Myomectomy
A single-post myomectomy uses only one opening near the navel for all the instruments but requires a fairly large incision. It’s performed under general anesthesia.
It typically has a quicker recovery time (up to a week) and is easier on the body than an open myomectomy.
Hysteroscopic Myomectomy
A hysteroscopic myomectomy is used for submucosal fibroids (found in the uterine cavity) and requires no incisions.
A camera with a specialized attachment is placed through the vagina into the uterus to remove fibroids.
This is performed under general orregional anesthesia.
Hysterectomy: Overview
Hysterectomy
During ahysterectomy, the uterus is removed, permanently ending menstruation, the ability to become pregnant, and the chance that fibroids will return.
There are three types of hysterectomies:
Other procedures that may be performed at the same time as a hysterectomy include:
Types of hysterectomy procedures include:
Total Abdominal Hysterectomy
Total abdominal hysterectomy is the traditional hysterectomy procedure. It is invasive surgery that requires an incision of five to seven inches in the lower abdomen. The incision may be vertical or horizontal.
A horizontal incision is made just above the pubic bone, in what’s known as a bikini cut. It heals faster and is less noticeable than a vertical cut. A vertical incision is used for more complicated cases or for the removal of very large fibroids.
Total abdominal hysterectomy also:
Vaginal Hysterectomy
This procedure requires a hospital stay of one to three daysand rest for two weeks.
Laparoscopically Assisted Vaginal Hysterectomy (LAVH)
Laparoscopically Assisted Vaginal Hysterectomy (LAVH) uses several small abdominal incisions through which the surgeon divides the attachments to the uterus and—if needed—the ovaries. Part of the procedure is completed vaginally.
This procedure has shorter hospital stays, and faster recovery times than abdominal hysterectomy.
Total Laparoscopic Hysterectomy
This procedure uses a laparoscope (a thin, flexible tube through which a tiny video camera and surgical instruments are inserted).
Typically, there are shorter hospital stays and faster recovery times than abdominal hysterectomies.
Robotic-Assisted Laparoscopic Hysterectomy
This is a type of laparoscopic hysterectomy in which the surgical instruments are attached to a robot and the surgeon uses a computer console in the operating room to control the robot’s movements.
The ACOG indicates that robotic hysterectomy is best suited for complex hysterectomies, so it is important to find a surgeon who has extensive training and experience in this technique.
The use of robotic-assisted laparoscopic hysterectomy increased exponentially in popularity between 2005 and 2015.In fact, up to 9.5% ofhysterectomieswere done with the assistance of a robot in research looking back at previously recorded data involving 264,758 cases.
Some things to consider:
A Warning About Laparoscopic Power MorcellationLaparoscopic power morcellation is a procedure that breaks uterine fibroids into small pieces using a medical device, allowing them to be removed through a small incision in the abdomen.The Food and Drug Administration (FDA) has issued a warning about this procedure. If the person also has uterine cancer, this procedure may cause cancer to spread within the abdomen and pelvis, making cancer harder to treat.
A Warning About Laparoscopic Power Morcellation
Laparoscopic power morcellation is a procedure that breaks uterine fibroids into small pieces using a medical device, allowing them to be removed through a small incision in the abdomen.The Food and Drug Administration (FDA) has issued a warning about this procedure. If the person also has uterine cancer, this procedure may cause cancer to spread within the abdomen and pelvis, making cancer harder to treat.
Laparoscopic power morcellation is a procedure that breaks uterine fibroids into small pieces using a medical device, allowing them to be removed through a small incision in the abdomen.
The Food and Drug Administration (FDA) has issued a warning about this procedure. If the person also has uterine cancer, this procedure may cause cancer to spread within the abdomen and pelvis, making cancer harder to treat.
Benefits
Disadvantages
Complications/Risks
Complicationsfrom these surgeries are similar to those of any major surgery. They may include:
Nonsurgical treatment options for fibroids are also available.
Watchful Waiting
Fibroids that are not causing problems or bothersome symptoms do not necessarily need treatment. A wait-and-see approach may be appropriate in these cases.
With watchful waiting, the fibroids are monitored for changes and growth through regular pelvic exams and/or ultrasounds.
Medications
Some medications used to treat fibroids include:
Medical Procedures
Uterine Artery Embolization(UAE)
Radiofrequency Ablation
Magnetic Resonance Imaging–Guided Focused Ultrasound (MRgFUS)
Magnetic resonance imaging–guided focused ultrasound (MRgFUS) is a noninvasive procedure that uses high-intensity ultrasound waves to generate heat and destroy fibroids. The procedure is performed with a device called the ExAblate, which combines magnetic resonance imaging (MRI) with ultrasound.
It is a three-hour procedure where a person lies in anMRI machinewhile conscious but given a mild sedative. A radiologist uses the MRI to target the fibroid tissue and direct the ultrasound beam.
Things to note about this procedure include:
Endometrial Ablation
Endometrial ablation destroys the endometrium (the lining of the uterus). This procedure is typically used to stop heavy menstrual bleeding and for removing small fibroids. It’s not useful for large fibroids or for fibroids that have grown outside of the interior uterine lining.
Endometrial ablation usually stops or significantly reduces monthly menstruation and can significantly decrease the likelihood of pregnancy. Things to note about this procedure include:
What size fibroids need surgery?
There isn’t a specific size of fibroid that would automatically determine a need for its removal. The need for treatment is largely based on symptoms, not size.
How do you get rid of fibroids without surgery?
Nonsurgical options for fibroid treatment include:
How does a doctor determine if surgery is necessary for uterine fibroids?
Healthcare providers take a number of factors into account when deciding on treatment for fibroids, including surgery. Some things they consider include:
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cruz MSDDL, Buchanan EM.Uterine fibroids: diagnosis and treatment.AFP. 95(2):100-107.Mount Sinai.Uterine fibroids and hysterectomy.Khan A, Shehmar M, Gupta J.Uterine fibroids: current perspectives.IJWH. Published online January 2014:95. doi:10.2147/IJWH.S51083Vilos GA, Allaire C, Laberge P-Y, et al.The management of uterine leiomyomas.Journal of Obstetrics and Gynecology Canada. 37(2):157-178.Cleveland Clinic.Myomectomy.Office On Women’s Health.Uterine fibroids.healthdirect.Vaginal hysterectomy.U.S. Food & Drug Administration.Laparoscopic power morcellators.Malek-Mellouli M, Ben Amara F, Youssef A, et al.Hysteroscopic myomectomy.Tunis Med.90:458–462.Marsh EE, Al-Hendy A, Kappus D, Galitsky A, Stewart EA, Kerolous M.Burden, prevalence, and treatment of uterine fibroids: a survey of u. S. women.J Womens Health (Larchmt). 2018;27(11):1359-1367. doi:10.10892Fjwh.2018.7076Harvard Health Publishing.What to do about fibroids.Cleveland Clinic.Hysterectomy.MedlinePlus.Uterine fibroids.Camran Nezhat Institute.Uterine fibroid tumors - question about fibroids.Cleveland Clinic.Uterine fibroids.
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cruz MSDDL, Buchanan EM.Uterine fibroids: diagnosis and treatment.AFP. 95(2):100-107.Mount Sinai.Uterine fibroids and hysterectomy.Khan A, Shehmar M, Gupta J.Uterine fibroids: current perspectives.IJWH. Published online January 2014:95. doi:10.2147/IJWH.S51083Vilos GA, Allaire C, Laberge P-Y, et al.The management of uterine leiomyomas.Journal of Obstetrics and Gynecology Canada. 37(2):157-178.Cleveland Clinic.Myomectomy.Office On Women’s Health.Uterine fibroids.healthdirect.Vaginal hysterectomy.U.S. Food & Drug Administration.Laparoscopic power morcellators.Malek-Mellouli M, Ben Amara F, Youssef A, et al.Hysteroscopic myomectomy.Tunis Med.90:458–462.Marsh EE, Al-Hendy A, Kappus D, Galitsky A, Stewart EA, Kerolous M.Burden, prevalence, and treatment of uterine fibroids: a survey of u. S. women.J Womens Health (Larchmt). 2018;27(11):1359-1367. doi:10.10892Fjwh.2018.7076Harvard Health Publishing.What to do about fibroids.Cleveland Clinic.Hysterectomy.MedlinePlus.Uterine fibroids.Camran Nezhat Institute.Uterine fibroid tumors - question about fibroids.Cleveland Clinic.Uterine fibroids.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Cruz MSDDL, Buchanan EM.Uterine fibroids: diagnosis and treatment.AFP. 95(2):100-107.Mount Sinai.Uterine fibroids and hysterectomy.Khan A, Shehmar M, Gupta J.Uterine fibroids: current perspectives.IJWH. Published online January 2014:95. doi:10.2147/IJWH.S51083Vilos GA, Allaire C, Laberge P-Y, et al.The management of uterine leiomyomas.Journal of Obstetrics and Gynecology Canada. 37(2):157-178.Cleveland Clinic.Myomectomy.Office On Women’s Health.Uterine fibroids.healthdirect.Vaginal hysterectomy.U.S. Food & Drug Administration.Laparoscopic power morcellators.Malek-Mellouli M, Ben Amara F, Youssef A, et al.Hysteroscopic myomectomy.Tunis Med.90:458–462.Marsh EE, Al-Hendy A, Kappus D, Galitsky A, Stewart EA, Kerolous M.Burden, prevalence, and treatment of uterine fibroids: a survey of u. S. women.J Womens Health (Larchmt). 2018;27(11):1359-1367. doi:10.10892Fjwh.2018.7076Harvard Health Publishing.What to do about fibroids.Cleveland Clinic.Hysterectomy.MedlinePlus.Uterine fibroids.Camran Nezhat Institute.Uterine fibroid tumors - question about fibroids.Cleveland Clinic.Uterine fibroids.
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Mount Sinai.Uterine fibroids and hysterectomy.
Khan A, Shehmar M, Gupta J.Uterine fibroids: current perspectives.IJWH. Published online January 2014:95. doi:10.2147/IJWH.S51083
Vilos GA, Allaire C, Laberge P-Y, et al.The management of uterine leiomyomas.Journal of Obstetrics and Gynecology Canada. 37(2):157-178.
Cleveland Clinic.Myomectomy.
Office On Women’s Health.Uterine fibroids.
healthdirect.Vaginal hysterectomy.
U.S. Food & Drug Administration.Laparoscopic power morcellators.
Malek-Mellouli M, Ben Amara F, Youssef A, et al.Hysteroscopic myomectomy.Tunis Med.90:458–462.
Marsh EE, Al-Hendy A, Kappus D, Galitsky A, Stewart EA, Kerolous M.Burden, prevalence, and treatment of uterine fibroids: a survey of u. S. women.J Womens Health (Larchmt). 2018;27(11):1359-1367. doi:10.10892Fjwh.2018.7076
Harvard Health Publishing.What to do about fibroids.
Cleveland Clinic.Hysterectomy.
MedlinePlus.Uterine fibroids.
Camran Nezhat Institute.Uterine fibroid tumors - question about fibroids.
Cleveland Clinic.Uterine fibroids.
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