Our Summary

This research paper investigates how often and why intrauterine adhesions (scar tissue inside the uterus) occur after a type of surgery called an abdominal myomectomy, which is performed to remove fibroids from the uterus. Fibroids are non-cancerous growths that can cause a range of problems, including infertility.

The researchers looked at 11 studies, and found that anywhere from 1% to 50% of women who underwent this surgery developed these adhesions. They found that these adhesions occurred more often in patients who had an open abdominal surgery compared to those who had a minimally invasive procedure. The scar tissue was severe in about a third of the cases.

The study also looked at what could potentially increase the risk of developing these adhesions. They found that the characteristics of the fibroids, such as their size and number, could be a risk factor. However, there was no agreement on other risk factors.

The researchers concluded that these adhesions are likely more common and unpredictable than currently thought. They suggest that women who have had this surgery should have a follow-up procedure called a hysteroscopy, which allows doctors to look inside the uterus to check for these adhesions. They also call for more research to better understand the risk factors and incidence of these adhesions after this surgery.

FAQs

  1. What is an abdominal myomectomy and why is it performed?
  2. What factors increase the risk of developing intrauterine adhesions after an abdominal myomectomy?
  3. What is the recommended follow-up procedure after having an abdominal myomectomy and why is it necessary?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy is to discuss the potential risk of developing intrauterine adhesions (scar tissue inside the uterus) after the surgery. It is important for patients to be aware of this possible complication and to follow up with their doctor for monitoring and further evaluation if needed. Additionally, patients should consider discussing with their doctor the option of a hysteroscopy to check for any adhesions post-surgery.

Suitable For

Generally, patients who are recommended for myomectomy are those who have symptomatic fibroids that are causing pain, heavy menstrual bleeding, or fertility problems. Myomectomy is a good option for women who want to preserve their fertility and have the fibroids removed while keeping the uterus intact. It is also recommended for women who have fibroids that are causing pressure on other organs, such as the bladder or rectum.

Additionally, myomectomy may be recommended for women who have tried other treatments for their fibroids, such as medication or hormonal therapy, but have not seen improvement in their symptoms. Women who have fibroids that are rapidly growing or those who have multiple fibroids may also be good candidates for myomectomy.

Overall, the decision to recommend myomectomy is based on the individual patient’s symptoms, medical history, and goals for future fertility. It is important for patients to discuss their options with their healthcare provider to determine the best treatment plan for their specific situation.

Timeline

Before a myomectomy, a patient may experience symptoms such as heavy menstrual bleeding, pelvic pain, pressure on the bladder or rectum, and infertility. They may undergo tests such as an ultrasound or MRI to diagnose the presence of fibroids. The patient will then have a consultation with their doctor to discuss the risks and benefits of the surgery, as well as alternative treatment options.

After the myomectomy, the patient will typically stay in the hospital for 1-2 days to recover. They may experience some pain, cramping, and vaginal bleeding in the days following the surgery. The patient will need to avoid strenuous activities for several weeks and follow their doctor’s instructions for pain management and wound care.

In the months following the myomectomy, the patient should see improvements in their symptoms such as decreased menstrual bleeding and pelvic pain. If the patient was experiencing infertility due to the fibroids, they may have an increased chance of getting pregnant after the surgery. However, there is a risk of developing intrauterine adhesions, as mentioned in the research paper, which may require further treatment. Regular follow-up appointments with the doctor are important to monitor the patient’s recovery and address any concerns.

What to Ask Your Doctor

  1. What is a myomectomy and why is it recommended for me?
  2. What are the potential risks and complications of a myomectomy?
  3. What is the likelihood of developing intrauterine adhesions after a myomectomy?
  4. What are the symptoms of intrauterine adhesions and how are they diagnosed?
  5. What are the treatment options for intrauterine adhesions if they occur?
  6. What can I do to reduce my risk of developing intrauterine adhesions after a myomectomy?
  7. How soon after a myomectomy should I have a follow-up hysteroscopy to check for adhesions?
  8. Are there any specific factors about my fibroids that may increase my risk of developing adhesions?
  9. How will the presence of adhesions affect my future fertility or pregnancy?
  10. Are there any lifestyle changes or precautions I should take after a myomectomy to reduce my risk of developing adhesions?

Reference

Authors: Poulsen BB, Kracht MB, Dueholm M. Journal: Eur J Obstet Gynecol Reprod Biol. 2025 Aug;312:114095. doi: 10.1016/j.ejogrb.2025.114095. Epub 2025 Jun 3. PMID: 40494172