Our Summary

This research paper discusses uterine fibroids, which are common tumors in women of reproductive age. These fibroids can cause a variety of symptoms that can negatively impact a woman’s daily life. Drug treatments may not always be effective and can sometimes be expensive and have side effects.

In severe cases, a surgical procedure called a myomectomy is required. This procedure, which can be done in several ways, removes the fibroids while leaving the uterus intact. However, because the uterus has a large blood supply, myomectomy can lead to significant bleeding during and after the surgery, along with related complications.

This paper looks at the typical methods used to reduce bleeding during and after a myomectomy. These include both chemical treatments (like vasopressin, octreotide, tranexamic acid, and uterotonics) and mechanical strategies (like uterine artery clamps, embolization, and tourniquets).

The paper also discusses a specific surgical method called intracapsular myomectomy, which does not rely on the traditional approaches mentioned earlier. This method takes advantage of the biological and anatomical characteristics of the fibroid, allowing it to be removed from its surrounding tissue. This technique, based on the fibroid’s own biology, can reduce bleeding during myomectomy.

FAQs

  1. What is a myomectomy and why is it used in severe cases of uterine fibroids?
  2. What are some methods used to reduce bleeding during and after a myomectomy?
  3. Can you explain what intracapsular myomectomy is and how it differs from traditional surgical methods?

Doctor’s Tip

A helpful tip a doctor might tell a patient about myomectomy is to discuss the potential risks and benefits of the surgery, including the possibility of excessive bleeding. Patients should be aware of the different methods that can be used to reduce bleeding during the procedure and should feel comfortable asking their doctor about these options. It is important for patients to have a clear understanding of the surgical technique that will be used and to feel confident in their doctor’s expertise in performing the procedure.

Suitable For

Patients who are typically recommended for a myomectomy are those who have symptomatic fibroids that are causing significant discomfort or affecting their quality of life. Symptoms of fibroids can include heavy menstrual bleeding, pelvic pain, pressure on the bladder or bowels, and infertility.

Women who wish to preserve their fertility and have not been successful with other treatment options may also be good candidates for myomectomy. Additionally, women who are not candidates for a hysterectomy (surgical removal of the uterus) due to personal or medical reasons may opt for a myomectomy instead.

It is important for patients considering a myomectomy to discuss their options with their healthcare provider and weigh the potential risks and benefits of the procedure. Each patient’s individual circumstances and medical history will play a role in determining the best course of treatment for their fibroids.

Timeline

Before a myomectomy, a patient may experience symptoms such as heavy menstrual bleeding, pelvic pain, frequent urination, and pressure or fullness in the abdomen. They may undergo imaging tests such as ultrasound or MRI to diagnose the fibroids and determine the best course of treatment.

During the myomectomy surgery, the patient will be under general anesthesia and the surgeon will make an incision in the abdomen to access the uterus. The fibroids will be removed, either by cutting them out or by using techniques such as morcellation or enucleation. The surgeon will then close the incision, and the patient will be monitored in the recovery room before being discharged from the hospital.

After the myomectomy, the patient may experience some pain and discomfort, which can be managed with pain medication. They will need to follow post-operative care instructions, such as avoiding heavy lifting and strenuous activity for a period of time. The patient will have follow-up appointments with their doctor to monitor their recovery and ensure that the fibroids do not return.

Overall, a myomectomy can provide relief from symptoms caused by uterine fibroids and preserve the uterus for future fertility. The choice of surgical technique and post-operative care can help minimize complications such as bleeding and ensure a successful outcome for the patient.

What to Ask Your Doctor

Some questions a patient should ask their doctor about myomectomy include:

  1. What are the potential risks and complications associated with myomectomy?
  2. What are the different types of myomectomy procedures available, and which one would be most suitable for my case?
  3. How long is the recovery period after myomectomy, and what can I expect during this time?
  4. Will my fertility be affected by undergoing a myomectomy?
  5. Are there any alternative treatments to myomectomy that I should consider?
  6. What are the chances of the fibroids recurring after myomectomy?
  7. How will you ensure that bleeding is minimized during and after the surgery?
  8. What is your experience with performing myomectomy procedures, and what is the success rate?
  9. What post-operative care will be required, and how often will follow-up appointments be needed?
  10. Are there any lifestyle changes or precautions I should take before and after myomectomy to ensure the best outcome?

Reference

Authors: Tinelli A, Pecorella G, Panese G, Morciano A, Malvasi A, Medvediev M, Hatirnaz S, Sparic R, Stark M. Journal: Med Sci (Basel). 2025 Jun 1;13(2):68. doi: 10.3390/medsci13020068. PMID: 40559226