What are the advantages of myomectomy?

Myomectomy is the only surgical treatment of myomas that preserves fertility.  The safety of pregnancy after uterine artery embolization has not been established, and pregnancy is impossible after hysterectomy.  The average reduction in volume of fibroids after a UAE is 50%, where fibroids that have removed are completely gone. 

The purpose of myomectomy is to restore the uterus to normal function.  Symptoms such as heavy bleeding and pressure usually decrease or are gone once the fibroids are removed. 

What are the disadvantages of myomectomy?

Fibroids can recur.  While fibroids that are removed cannot recur, fibroids that are left behind can grow, and new ones can form.  Sometimes a uterus may have a single or a few large fibroids, and the recurrence risk would be expected to be low.  On the other hand a uterus with multiple tiny fibroids would run a higher risk of recurrence since it may be impossible to find all extremely small fibroids.

Another possible problem is that severe adenomyosis can occur in  addition to the fibroids.   This could lead to pain and heavy bleeding.  As adenomyosis is commonly mistaken for fibroids, it is essential to have proper diagnosis before surgery! 

What about uterine artery embolization (UAE)?

UAE is a new procedure in which tiny particle are injected through blood vessels to block the arteries supplying fibroids.  This causes degeneration of the fibroids and decrease in size and symptoms.  Click here to learn more about UAE.  It is very important to be evaluated by a gynecologist familiar with UAE as well as other options before choosing UAE, as often the specialists in UAE are not experts in the management of fibroids.

When is a hysterectomy necessary?

Hysterectomy - the removal of the uterus - is rarely required for the treatment of fibroids.  Nevertheless, it can be a reasonable option for women who do not want to remain fertile.  Hysterectomy is the only treatment with the guarantee that there will be no further menstrual bleeding.  It guarantees that there will be no recurrence of fibroids.  Hysterectomy is the only sure treatment for adenomyosis.  Some women who want to have these guarantees but wish to have as little removed as possible elect to have a supracervical hysterectomy — a procedure in which the body of the uterus with the fibroids is removed and the cervix is left. 

Since this site is about myomectomy, a detailed discussion of hysterectomy is beyond it's scope.