Myomectomy: removing fibroids while keeping the womb

Fibroids are non-cancerous growths in or around the womb. Many cause no trouble, but they can bring heavy or painful periods, pressure on the bladder or bowel, pain with sex and sometimes difficulty conceiving, as the NHS describes. Myomectomy is aimed at people who want symptom relief and who wish to keep the womb, often because they hope for a pregnancy.

The NHS states that fibroid surgery is not suitable for everyone and that the right treatment depends on the size, number and location of the fibroids. People whose fibroids cause no symptoms generally need no treatment. Medicines such as tranexamic acid or hormonal contraceptives, uterine artery embolisation, which blocks the blood supply to shrink them, endometrial ablation and hysterectomy are the other options the NHS lists.

An MRI map of the fibroids is often requested beforehand, because the plan depends on where each one sits.

Fibroid operations can involve blood loss, so anaemia is usually treated before the operation, and the team will check blood counts and medicines. Smoking delays healing and raises infection risk; stopping early helps. Some surgeons offer hormone injections beforehand to shrink fibroids, and the aims of that decision should be explained.

The Worcestershire keyhole leaflet says you may be told to stop eating and drinking six to eight hours before the operation; follow your own hospital letter. Plan childcare, a lift home and help for the first weeks.

• Report heavy bleeding patterns; they influence blood-saving plans.

• Ask whether tranexamic acid or iron should be started before surgery.

• Discuss consent for hysterectomy as a last resort if bleeding cannot be controlled.

In an open abdominal myomectomy, the surgeon cuts through the lower abdomen, either along the bikini line or in the middle, opens the womb wall over each fibroid, removes it and repairs the muscle in layers. This route suits large or many fibroids.

In a keyhole operation several small cuts allow a camera and instruments; the womb is repaired with stitches, and the removed fibroids are cut into pieces and taken out. The Worcestershire leaflet gives two to three hours as usual. A hysteroscopic myomectomy removes fibroids that protrude into the cavity through the cervix, with no cut on the abdomen.

All of the abdominal routes use a general anaesthetic. How long you stay depends on the route and your recovery.

The leaflets and NHS pages list bleeding, which occasionally requires a transfusion, infection, injury to the bowel, bladder or blood vessels, scar tissue, and an operation that has to be converted to a larger cut. In a small number of operations, uncontrolled bleeding can lead to a hysterectomy, which is why consent is discussed in advance.

Fibroids can grow back. Pregnancy after myomectomy may need closer monitoring, and the surgeon may advise a planned caesarean if the wall of the womb was deeply involved. None of the pages retrieved gives percentages for these, so ask for figures that reflect your fibroids.

The Ashford and St Peter's leaflet describes a stay of about two days after abdominal surgery, showering the day after, vaginal bleeding for a couple of weeks, work after four to six weeks, avoiding penetrative sex for four to six weeks and avoiding vigorous sport and swimming for about six weeks. The Worcestershire leaflet likewise says keyhole patients may go home the same day or after one or two nights and need four to six weeks off work.

On driving, the Ashford leaflet says not for 24 hours after a general anaesthetic and then typically two to four weeks, once you can operate the controls comfortably and make an emergency stop. GOV.UK says the DVLA must be told if you are still unable to drive three months after surgery.

• A temperature, or wound redness, swelling or discharge.

• Heavy or painful vaginal bleeding after the first days.

• Inability to pass urine, or severe tummy pain that painkillers do not ease.

• Calf pain, chest pain or breathlessness: call 999 if severe.

• Which route do you recommend for my fibroids and why?

• How will you reduce blood loss, and what is the plan if it is heavy?

• How long should I wait before trying for a baby?

• Would a caesarean be advised in any later pregnancy?

• What are the chances the fibroids return?

The surgical options are similar in both settings, but not every unit offers keyhole myomectomy for larger fibroids, so access to a specialist surgeon matters more than the sector. Waiting times and the choice of surgeon differ. If paying, ask what is covered if a transfusion or a longer stay is needed.