Hysterectomy risk:
One of the most worrying things about having fibroids removed is the risk of Hysterectomy. This happens very rarely and only to save life if there is uncontrollable bleeding. Everything will be done to try and control the bleeding, and hysterectomy will only be a last resort. I quote the figure of about 1:250 putting this in perspective if I were do perform a laparoscopy a week it would take 5 years for this complication to occur.
Fertility issues:
Though you may be having your operation for fertility reasons, it doesn’t automatically mean you will get pregnant after a myomectomy. Removal of fibroids can however improve fertility particularly if they are causing obstruction to fallopian tubes or occupy or indent the cavity of the womb. (See blog about fibroids and fertility I)
Symptoms:
For women who have pressure symptoms those will definitely improve. For those with heavy periods the majority will improve however in about 5-10% of women symptoms will remain. With between 5-10% of women needing a further procedure within 5-10years. Again the need for another procedure will depend on whether there are residual fibroids or whether new fibroids have regrown.
Recurrence (new growth)
Once fibroids have been removed they cannot regrow but new ones may take their place.
The risk of this is anywhere between 5-40% depending on whether symptoms are taken into consideration or routine screening looking for fibroids after a myomectomy.
In one report women had an ultrasound scan to ensure all fibroids were removed 2 weeks after myomectomy and were then followed up for 3 years. 15% had new fibroids of 2cm or more at 3 year follow up.
The younger you are at time of operation the more likely it is that new ones will grow. The more fibroids there are at operation the more likely it is that new ones will develop. If only one fibroid is removed the quoted risk is 10% within 10 years. If many fibroids are removed this increases to about 25-30%.
New fibroid growth is not more common after laparoscopic compared to traditional open myomectomy. In one scientific study 81 women were randomized to either open or laparoscopic myomectomy and were followed up with ultrasound for nearly three and a half years there was no significant difference in new fibroid growth (27% vs. 23%)
If women are lucky enough to get pregnant they are less likely to have growth of new fibroids. One study found that at 10 years only 15% of women who had been pregnant had fibroids whereas nearly 30% of those who had not been pregnant had fibroids.
Sometimes the use of medication (GnrH) to shrink the fibroids prior to surgery may increase the risk of fibroids being missed at surgery. One report showed that only 13% of women had fibroids left behind without therapy whereas 63% who had GnrHa therapy had fibroids left behind.
If you do decide to have a myomectomy and plan on adding to your family this is best done sooner rather than later because
- Fertility decreases with increasing age particularly after the age of 35years
- There is the risk of growing new fibroids and the risk that symptoms may return. Should this be the case once family is complete more radical measures can be used to treat the fibroids