Myomectomy in Chicago — Fibroid Removal That Keeps Your Uterus

A myomectomy removes uterine fibroids and leaves the uterus in place. That is the entire point of it. Where a hysterectomy ends fibroid symptoms by removing the organ, a myomectomy takes out the fibroids and repairs the uterine wall, so pregnancy remains possible and the uterus stays yours.

Fibroids are benign muscular growths. They are extremely common, and most cause no trouble at all. Surgery is for the ones that do.

Why a myomectomy is done

Fibroids are worth treating when they are causing real problems:

• Heavy or prolonged menstrual bleeding, often with iron-deficiency anemia — fatigue, breathlessness on stairs, feeling cold
• Pelvic pressure or a feeling of fullness, sometimes visible abdominal enlargement
• Urinary frequency or difficulty emptying the bladder, from a fibroid pressing forward
• Constipation or rectal pressure, from one pressing backward
• Pain during intercourse
• Infertility or recurrent pregnancy loss, particularly with submucosal fibroids distorting the uterine cavity
• Rapid growth or a fibroid that needs surgical characterization

Size alone is not a reason to operate. Neither is the mere presence of fibroids on an ultrasound report. Symptoms and their effect on your life are what justify surgery.

The approaches

Which route is possible depends on where the fibroids sit, how many there are, and how large.

Hysteroscopic myomectomy. For submucosal fibroids that bulge into the uterine cavity. The fibroid is removed through the cervix with a scope — no incision at all. This is the least invasive option and often the most effective for bleeding and for fertility, because the cavity is what implantation depends on. See hysteroscopy. Very large or deeply embedded submucosal fibroids may require two staged procedures.

Laparoscopic or robotic-assisted myomectomy. For fibroids in or on the uterine wall. Several small abdominal incisions; the fibroid is removed from the muscle and the wall closed in layers with sutures. Recovery is substantially faster than open surgery. Suits a limited number of fibroids of moderate size. See laparoscopy.

Abdominal (open) myomectomy. A single incision, usually low and horizontal. Chosen for numerous fibroids, very large fibroids, or locations that make minimally invasive repair of the uterine wall unreliable. The repair quality matters — a uterus that may carry a pregnancy has to be closed well, and that consideration sometimes correctly favors an open approach.

Minimally invasive routes are preferred where they are feasible and safe. Ask which applies to your fibroid map, and why.

Fertility, pregnancy, and delivery afterward

This is the reason most women choose myomectomy, so it deserves plain talk.

Fertility. Removing submucosal fibroids that distort the uterine cavity improves the chance of conception and reduces miscarriage risk. The benefit of removing fibroids that sit entirely within the muscle wall or on the outer surface is less clear, and surgery is not automatically justified simply because you want to conceive. If fertility is the goal, the decision should be made together with your fertility evaluation. See infertility.

Waiting to conceive. After a myomectomy involving the uterine muscle, you will usually be advised to wait roughly three to six months before trying, so the uterine wall heals fully. Your surgeon will give you a specific interval based on how deep the repair went.

Delivery. If the incision entered deeply into the uterine muscle, a planned caesarean delivery is generally recommended for future pregnancies, because a repaired uterine wall carries a risk of rupture in labor. After a purely hysteroscopic myomectomy, vaginal delivery is usually still possible. Get the specific answer for your surgery in writing in your operative report — it will matter to whoever cares for you in pregnancy. See labor and delivery and prenatal care.

Recurrence. Myomectomy removes the fibroids you have. It does not stop new ones from forming, and recurrence over the following years is common — more likely when many fibroids were removed and when you are younger at the time of surgery. Some women eventually need a second procedure. That is not a failure of the operation; it is the nature of the condition. If you are close to menopause, symptoms often settle on their own as hormone levels fall. See menopause management.

Alternatives worth considering first

• Watchful waiting. Asymptomatic fibroids generally need monitoring, not surgery.
• Levonorgestrel IUD. Reduces heavy bleeding substantially when the cavity is not badly distorted. Reversible and office-placed. See birth control.
• Medication. Tranexamic acid during periods, NSAIDs, combined hormonal contraceptives, progestins, and newer oral therapies can control bleeding without surgery. Some medications shrink fibroids temporarily and are used before surgery to correct anemia and reduce size.
• Endometrial ablation. For bleeding when childbearing is complete and the cavity is suitable. Not compatible with future pregnancy.
• Uterine artery embolization (UAE). Shrinks fibroids by cutting their blood supply, without an abdominal incision. Effects on fertility are not fully defined, so it is generally offered to women not planning pregnancy.
• **Hysterectomy.** Definitive, with no recurrence — appropriate when childbearing is complete and symptoms are severe, and only after you have heard the uterus-sparing options.

What to expect

Before. Ultrasound and often MRI to map the number, size, and exact position of every fibroid — this determines the surgical route. Blood count checked, and anemia treated with iron before surgery. Sometimes a medication for two to three months to shrink fibroids and improve your blood count. Blood thinners stopped as directed. Nothing by mouth after midnight.

During. General anesthesia. Hysteroscopic cases often take under an hour; laparoscopic and abdominal myomectomies commonly run two to four hours depending on the number of fibroids. Blood loss can be significant with large or multiple fibroids, which is why blood is sometimes typed and crossmatched in advance.

After. Hysteroscopic myomectomy is usually same-day. Laparoscopic is same-day or one night. Abdominal myomectomy typically means one to two nights in hospital. Expect cramping, and vaginal bleeding or spotting for days to a few weeks.

Recovery timeline

• Hysteroscopic: cramping for a day or two, normal activity within two to five days, light bleeding up to two weeks.
• Laparoscopic or robotic: desk work in roughly one to two weeks, no lifting over ten to fifteen pounds for about four weeks, full activity and intercourse cleared around four to six weeks.
• Abdominal: four to six weeks off work depending on your job, six weeks before heavy lifting or strenuous exercise, and often two to three months before you feel entirely yourself.

Your first period after surgery may be heavier or come off schedule. Improvement in bleeding is usually noticeable within the first few cycles.

Risks

• Bleeding, occasionally requiring transfusion — a more prominent risk here than in many gynecologic operations
• Conversion to hysterectomy during surgery if bleeding cannot be controlled. Rare, but a possibility you consent to. Discuss it explicitly beforehand.
• Infection
• Injury to bladder, bowel, or ureters
• Blood clots
• Adhesions, which can themselves affect fertility
• Uterine rupture in a later pregnancy, uncommon but the reason for caesarean recommendations
• Fibroid recurrence
• Anesthesia complications

Call us for fever over 100.4°F, heavy bleeding, worsening pain, incision drainage, chest pain, breathing difficulty, or calf pain and swelling.

Book a consultation

Dr. Adeeb Alshahrour, MD, FACOG, is a board-certified obstetrician-gynecologist practicing at the Women's Health Center of Chicago, 4009 W Fullerton Ave. If fibroids are affecting your life and you want to keep your uterus — whether for fertility or simply because it is yours — a consultation will map your fibroids, weigh the non-surgical options honestly, and tell you what myomectomy can and cannot promise.

Book a consultation, find our locations, or read about Dr. Alshahrour and our gynecological surgery services.

Medical disclaimer

This page is general education and is not personal medical advice. Whether myomectomy is right for you depends on your fibroid map, symptoms, fertility goals, and medical history, and can only be determined by a licensed physician who has evaluated you. Seek emergency care for heavy bleeding, severe pain, high fever, chest pain, or difficulty breathing.