Should i have fibroid surgery

Learn how we develop our content. To learn more about Healthwise, visit Healthwise. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. Updated visitor guidelines. Get the facts. Your options Have surgery to take out just your fibroids or to take out your uterus.

Don't have surgery. You can choose another treatment, such as over-the-counter pain medicine, hormones, or fibroid embolization. Key points to remember You might want to choose surgery if fibroids are making it hard for you to get pregnant or if you have other symptoms that affect your quality of life, and other treatments have not worked for you.

There are two surgical treatments for fibroids: taking fibroids out of the uterus myomectomy and removing the uterus hysterectomy. After menopause, fibroids usually get smaller or go away. If you are close to menopause, you could take nonsteroidal anti-inflammatory drugs NSAIDs such as ibuprofen or naproxen for pain or have fibroid embolization. You also could try birth control hormones, get a certain type of IUD , or take hormone therapy GnRH-a for a short time if you have bad symptoms.

If you want to have a baby, taking out just the fibroids may improve your chance of getting pregnant. But this type of surgery can lead to a problem with the placenta. It also can make a cesarean delivery more likely. Taking out the uterus is the only cure for uterine fibroids. But it's not a good choice if you want to have children or more children. You can't get pregnant after your uterus is taken out. Both types of surgery have short-term risks, such as blood loss and infection. Both surgeries also can cause scar tissue, which can cause pelvic pain and infertility.

What are uterine fibroids? Over time, the size, shape, location, and symptoms of fibroids may change. When do fibroids need to be treated? Uterine fibroids usually need treatment when they cause: Anemia from heavy fibroid bleeding.

Ongoing low back pain or a feeling of pressure in the lower belly. Trouble getting pregnant. Problems during pregnancy, such as miscarriage or preterm labor. Problems with the urinary tract or bowels.

Infection, if the tissue of a large fibroid dies. What should you know about surgery to take out just the fibroids? Surgery can be done: Through the vagina and into the uterus using a lighted scope. Through a large cut in the belly.

Through several small cuts in the belly using a lighted scope. This is called a laparoscopy. How well myomectomy works Taking out fibroids decreases menstrual bleeding and pelvic pain from fibroids. Chance that fibroids can come back Fibroids tend to grow back, unless you have your uterus taken out. Risks of myomectomy Cutting into the uterine wall during this surgery can cause problems in a future pregnancy. What should you know about surgery to take out the uterus?

This surgery gives most women relief from their symptoms. Stops anemia from heavy and irregular vaginal bleeding. May fix leakage of urine if it was caused by fibroids. Chance that fibroids can come back Fibroids do not grow back after your uterus is taken out. Risks of hysterectomy Most women don't have problems from this surgery. But possible long-term problems include: Scar tissue that can cause pelvic pain.

Early menopause caused by a slow, early decline of the ovaries. Weakness of the pelvic muscles and ligaments that support the vagina, bladder, and rectum. This can cause bladder or bowel problems. Trouble urinating. Pelvic pain. If you had pain before surgery, taking out your uterus may not relieve your pain. What are the risks of having either surgery?

But problems can include: A fever. A slight fever is common after any surgery. Rare problems, such as: Infection. Blood clots in the legs or lungs. Scar tissue also called adhesions. Injury to other organs, such as the bladder or bowel. A collection of blood at the surgical site. Continued heavy bleeding. Some vaginal bleeding within 4 to 6 weeks after you have the uterus removed is normal.

Problems from the medicine used to make you sleep during surgery. Severe blood loss that causes you to need more blood transfusion. Why might your doctor recommend surgery to treat fibroids? Your doctor might suggest that you have surgery to take out just your fibroids if: You want to treat your fibroids in a way that may make it possible for you to get pregnant later.

Your doctor might suggest that you have surgery to remove your uterus if: You have bad symptoms and : Other treatments have not helped.

You're not near menopause. You don't plan to have children or more children. There is a risk of cancer. Compare your options. Compare Option 1 Have surgery to take out fibroids or your uterus Don't have either surgery. Compare Option 2 Have surgery to take out fibroids or your uterus Don't have either surgery.

Have surgery to take out fibroids or your uterus Have surgery to take out fibroids or your uterus You may take the hormone GnRH-a before surgery to shrink your fibroids. You may have outpatient surgery, which means you would go home the same day. Or you may spend 1 to 4 days in the hospital after surgery.

Recovery can take from a few days to 6 weeks, depending on the type of surgery you have. If you have your uterus taken out, you won't be able to get pregnant. Either surgery can ease your pain and other symptoms.

Surgery to take out just your fibroids myomectomy may make it possible for you to get pregnant. Surgery to take out your uterus hysterectomy will cure your fibroids.

Both surgeries have risks, some of which are rare. Risks include bleeding, infection, and scar tissue. Cutting into the uterus to take out just the fibroids could cause a problem with how the uterus works in a future pregnancy. Pelvic pain that you had before either surgery may not get better.

If you have just the fibroids taken out but not the uterus, the fibroids can grow back. Don't have either surgery Don't have either surgery You may take hormones GnRH-a to shrink the fibroids. You may have other procedures such as fibroid embolization , endometrial ablation or magnetic resonance guided ultrasound.

You may choose to have surgery later if you change your mind. However, most steps don't reduce the risk of needing a transfusion. In general, studies suggest that there is less blood loss with hysterectomy than myomectomy for similarly sized uteruses.

Rare chance of spreading a cancerous tumor. Rarely, a cancerous tumor can be mistaken for a fibroid. Taking out the tumor, especially if it's broken into little pieces morcellation to remove through a small incision, can lead to spread of the cancer.

The risk of this happening increases after menopause and as women age. In , the Food and Drug Administration FDA cautioned against using a laparoscopic power morcellator for most women undergoing myomectomy. Therapy to shrink fibroids. Some hormonal therapies, such as GnRH agonist therapy, can also shrink your fibroids and uterus enough to allow your surgeon to use a minimally invasive surgical approach — such as a smaller, horizontal incision rather than a vertical incision, or a laparoscopic procedure instead of an open procedure.

Some research suggests that intermittent GnRH agonist therapy, over time, can shrink fibroids and decrease bleeding enough that surgery isn't needed. In most women, GnRH agonist therapy causes symptoms of menopause, including hot flashes, night sweats and vaginal dryness. However, these discomforts end after you stop taking the medication. Treatment generally occurs over several months before surgery. Evidence suggests that not all women should take GnRH agonist therapy before myomectomy.

GnRH agonist therapy may soften and shrink fibroids so much that their detection becomes more difficult. The cost of the medication and the risk of side effects must be weighed against the benefits. Another family of drugs called selective progesterone receptor modulators SPRMs , such as ulipristal ella , may also shrink fibroids and reduce bleeding.

Outside the United States, ulipristal is approved for three months of therapy before a myomectomy. You'll need to fast — stop eating or drinking anything — in the hours before your surgery.

Follow your doctor's recommendation on the specific number of hours. If you're on medications, ask your doctor if you should change your usual medication routine in the days before surgery. Tell your doctor about any over-the-counter medications, vitamins or other dietary supplements you're taking.

Sometimes other types of anesthesia, such as a spinal or local, may be used. Ask your doctor about the type of anesthesia you may receive. Whether you stay in the hospital for just part of the day or overnight depends on the type of procedure you have.

Abdominal myomectomy laparotomy usually requires a hospital stay of one to two days. In most cases, laparoscopic or robotic myomectomy is done outpatient or with only one overnight stay.

Hysteroscopic myomectomy is often done with no overnight hospital stay. Your facility may require that you have someone accompany you on the day of surgery. Make sure you have someone lined up to help with transportation and to be supportive. There are three major types of uterine fibroids. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus.

Some submucosal or subserosal fibroids may be pedunculated — hanging from a stalk inside or outside the uterus. Depending on the size, number and location of your fibroids, your surgeon may choose one of three surgical approaches to myomectomy.

In abdominal myomectomy laparotomy , your surgeon makes an open abdominal incision to access your uterus and remove fibroids. Your surgeon will generally prefer to make a low, horizontal "bikini line" incision, if possible. Vertical incisions are needed for larger uteruses. In laparoscopic or robotic myomectomy, both minimally invasive procedures, your surgeon accesses and removes fibroids through several small abdominal incisions. Compared with women who have a laparotomy, women who undergo laparoscopy have less blood loss, shorter hospital stays and recovery, and lower rates of complications and adhesion formation after surgery.

There are limited comparisons between laparoscopic and robotic myomectomy. Robotic surgery may take longer and be more costly, but otherwise few differences in outcomes are reported.

Sometimes, the fibroid is cut into pieces morcellation and removed through a small incision in the abdominal wall. Other times the fibroid is removed through a bigger incision in your abdomen so that it can be removed without being cut into pieces. A myomectomy is surgery to remove the fibroids from the wall of your womb.

It may be considered as an alternative to a hysterectomy if you'd still like to have children. But a myomectomy is not suitable for all types of fibroid. Your gynaecologist can tell you whether the procedure is suitable for you based on factors such as the size, number and position of your fibroids. Depending on the size and position of your fibroids, a myomectomy may involve making either a number of small incisions in your tummy keyhole surgery or a single larger incision open surgery.

Myomectomies are carried out under general anaesthetic and you'll usually need to stay in hospital for a few days afterwards. You'll be advised to rest for several weeks while you recover. Myomectomies are usually an effective treatment for fibroids, although there's a chance the fibroids will grow back and further surgery will be needed.

A hysteroscopic resection of fibroids is a procedure where a thin telescope hysteroscope and small surgical instruments are used to remove fibroids. The procedure can be used to remove fibroids from inside the womb submucosal fibroids and is suitable for women who want to have children in the future.

No incisions are needed because the hysteroscope is inserted through the vagina and into the womb through the entrance to the womb cervix. The procedure is often carried out under general anaesthetic, although local anaesthetic may be used instead.

You can usually go home on the same day as the procedure. After the procedure you may experience stomach cramps, but they should only last a few hours. There may also be a small amount of vaginal bleeding, which should stop within a few weeks. Hysteroscopic morcellation of fibroids is a new procedure where a clinician who's received specialist training uses a hysteroscope and small surgical instruments to remove fibroids.

The hysteroscope is inserted into the womb through the cervix and a specially designed instrument called a morcellator is used to cut away and remove the fibroid tissue. The procedure is carried out under a general or spinal anaesthetic.

You'll usually be able to go home on the same day. The main benefit of hysteroscopic morcellation compared with hysteroscopic resection is that the hysteroscope is only inserted once, rather than a number of times, reducing the risk of injury to the womb. But because hysteroscopic morcellation is a new technique, evidence about its overall safety and long-term effectiveness is limited.

As well as traditional surgical techniques to treat fibroids, non-surgical treatments are also available. Uterine artery embolisation UAE is an alternative procedure to a hysterectomy or myomectomy for treating fibroids. It may be recommended for women with large fibroids. UAE is carried out by a radiologist, a specialist doctor who interprets X-rays and scans. It involves blocking the blood vessels that supply the fibroids, causing them to shrink. During the procedure, a special solution is injected through a small tube catheter , which is guided by X-ray through a blood vessel in your leg.

It's carried out under local anaesthetic, so you'll be awake but the area being treated will be numbed. You'll usually need to stay in hospital a day or two after having UAE.

When you leave hospital, you'll be advised to rest for 1 to 2 weeks. Although it's possible to have a successful pregnancy after having UAE, the overall effects of the procedure on fertility and pregnancy are uncertain. It should therefore only be carried out after you have discussed the potential risks, benefits and uncertainties with your doctor.

Endometrial ablation is a relatively minor procedure that involves removing the lining of the womb. It's mainly used to reduce heavy bleeding in women without fibroids, but it can also be used to treat small fibroids in the womb lining. The affected womb lining can be removed in a number of ways — for example, by using laser energy, a heated wire loop, or hot fluid in a balloon.

The procedure can be carried out either under local anaesthetic or general anaesthetic. It's fairly quick to perform, taking around 20 minutes, and you can usually go home the same day. You may experience some vaginal bleeding and tummy cramps for a few days afterwards, although some women have bloody discharge for 3 or 4 weeks.

Some women have reported experiencing more severe or prolonged pain after having endometrial ablation. In this case, you should speak to a GP or a member of your hospital care team, who may be able to prescribe a stronger painkiller. It may still be possible to get pregnant after having endometrial ablation, but the procedure is not recommended for women who want to have more children because the risk of serious problems, such as miscarriage , is high.

Read Information for you after an endometrial ablation to find out more. There are also 2 relatively new techniques for treating fibroids that use MRI. These treatment methods cannot be used to treat all types of fibroids, and the long-term benefits and risks are unknown. Research is still being carried out, but there's some evidence to suggest that these non-invasive procedures have short- to medium-term benefits when performed by an experienced clinician.

But the effects on pregnancy and women who want to have a baby in the future are not fully known, so this should be taken into consideration.