Our Summary

This research paper looks at the occurrence of intrauterine adhesions (IUAs) - bands of scar tissue that form between the inner walls of the uterus - after a medical procedure called hysteroscopic myomectomy. This procedure is typically done to remove fibroids (non-cancerous growths) in the uterus.

The study was conducted at a hospital in Boston from January 2019 to February 2022, and included patients who were planning to have children in the future. The researchers found that out of 44 patients who had this procedure, 4 (or 9.1%) developed new IUAs.

In patients who had IUAs before the procedure, over half (55.6%) had a recurrence of these adhesions. Interestingly, the researchers found that the number, size, or depth of the fibroids removed didn’t affect the chances of new IUAs forming. Also, removing fibroids from opposite walls of the uterus during the same operation didn’t increase the risk.

The researchers conclude that the formation of IUAs after a hysteroscopic myomectomy is a known risk, and that their findings of 9.1% new IUAs and 55.6% recurrent IUAs contribute to existing knowledge on this topic. They suggest further study is needed, particularly for patients who have both a hysteroscopic myomectomy and lysis of adhesions (a procedure to break down scar tissue), as these patients seem to be at higher risk of developing IUAs.

FAQs

  1. What is the risk of developing intrauterine adhesions (IUAs) after a hysteroscopic myomectomy?
  2. Does the number, size, or depth of the fibroids removed in a hysteroscopic myomectomy affect the chances of new IUAs forming?
  3. Are patients who have both a hysteroscopic myomectomy and lysis of adhesions at a higher risk of developing IUAs?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy is to discuss the potential risk of intrauterine adhesions (IUAs) forming after the procedure. It is important for patients to be aware of this possible complication and to monitor for any symptoms such as changes in menstrual flow, pelvic pain, or infertility. Regular follow-up appointments with a healthcare provider can help detect and address any issues early on. Additionally, patients should discuss their future fertility plans with their doctor to determine the best course of action before and after the myomectomy procedure.

Suitable For

Patients who are typically recommended myomectomy are those who have symptomatic fibroids that are causing issues such as heavy menstrual bleeding, pelvic pain, or infertility. Myomectomy is often recommended for younger patients who want to preserve their fertility, as it allows them to remove the fibroids while keeping the uterus intact. Additionally, patients who have fibroids that are causing pressure symptoms, such as frequent urination or constipation, may also be recommended for myomectomy.

It is important for patients to discuss their individual circumstances with their healthcare provider to determine if myomectomy is the best treatment option for them. Factors such as the size, location, and number of fibroids, as well as the patient’s age, desire for future fertility, and overall health, will all play a role in determining the most appropriate treatment plan.

Timeline

Before myomectomy:

  • Patient experiences symptoms such as heavy menstrual bleeding, pelvic pain, and pressure
  • Patient undergoes diagnostic tests such as ultrasound or MRI to confirm the presence of fibroids
  • Patient discusses treatment options with their healthcare provider and decides to undergo myomectomy

After myomectomy:

  • Patient undergoes pre-operative preparation, which may include blood tests, imaging, and medication adjustments
  • Patient undergoes the myomectomy procedure, which can be done through different methods such as hysteroscopic, laparoscopic, or abdominal surgery
  • Patient stays in the hospital for a few days for recovery and monitoring
  • Patient may experience post-operative symptoms such as pain, bleeding, and fatigue
  • Patient follows up with their healthcare provider for post-operative care and monitoring of symptoms and any potential complications
  • Patient may undergo fertility treatments or work with a reproductive specialist if they are planning to have children in the future

Overall, the timeline for a patient before and after myomectomy can vary depending on individual circumstances and the specific details of the procedure. It is important for patients to discuss their treatment plan and expectations with their healthcare provider to ensure the best possible outcome.

What to Ask Your Doctor

  1. What is the likelihood of developing intrauterine adhesions (IUAs) after a hysteroscopic myomectomy?
  2. Are there any specific factors that may increase my risk of developing IUAs after the procedure?
  3. How will IUAs affect my chances of getting pregnant in the future?
  4. What are the symptoms of IUAs and how are they typically treated?
  5. Are there any measures I can take to reduce my risk of developing IUAs post-surgery?
  6. Will I need any follow-up procedures or monitoring to check for the presence of IUAs?
  7. How common are recurrent IUAs after a hysteroscopic myomectomy?
  8. Are there any alternative treatment options that may reduce the risk of IUAs?
  9. How will the presence of IUAs impact my overall reproductive health and fertility?
  10. Are there any lifestyle changes or medications that may help prevent the formation of IUAs after the procedure?

Reference

Authors: Zhang W, French H, O’Brien M, Movilla P, Isaacson K, Morris S. Journal: J Minim Invasive Gynecol. 2023 Oct;30(10):805-812. doi: 10.1016/j.jmig.2023.05.013. Epub 2023 May 27. PMID: 37247808