Comparing Myomectomy with hysterectomy for the management of fibroids
Management of symptomatic fibroids will always depend on the number, size and location of the fibroids.
Importantly however is the woman’s age and need for present or future reproductive capacity. In the ideal world once a woman’s family is complete and she remains symptomatic of her fibroids she should have definitive treatment, which would either be Uterine artery embolization or surgery
When surgery is considered comparing myomectomy and hysterectomy there are trade-offs in terms of benefits and drawbacks. When a myomectomy is performed;
Benefits: retaining the womb and potential reproductive capacity
Drawbacks:
The complications of a myomectomy include;
Adhesions, which can give, rise to
Pain and
Bowel obstruction,
Delayed recovery being a potentially bloody operation recovery can sometimes be delayed. There is also the risk of
New growth of fibroids.
If there is a reason to retain the womb for fertility purposes then these risks may be worth taking otherwise when family is complete and fertility no longer desired a hysterectomy might be a superior operation to myomectomy.
For women who do not want a hysterectomy
Understandably for a number of reasons women may not want to have their wombs removed. For this group of women the choices would either be a uterine artery embolization or a formal myomectomy either open myomectomy or laparoscopic, having weighed up the risks and benefits.
Young women who have not completed their family and fertility desire is not immediate
The hardest group of women to advise are those who have relatively asymptomatic fibroids are young and have no children because of the inherent risk of hysterectomy with whatever modality they choose to treat the symptoms of their fibroids. Though the risk is low (about 1:100-250) it is a real risk.
Traditionally the advice was to keep the fibroids try for pregnancy and if pregnancy does not happen then come and have the fibroids removed. However no one knows what the natural progression of growth of fibroids are. There are studies that have looked at growth difference between women over time and growth of different fibroids in the same woman and the conclusion is that no two fibroids grow at the same rate either in different women or in the same individual.
With increasing advancements in laparoscopic surgery for the management of fibroids and because it is not as traumatic as open surgery, with less risk of adhesion formation, it may be appropriate to advise these women to have a laparoscopic myomectomy while the fibroids are still of a manageable size. The cut off point would be 5cm or more.