Myoma surgery: when it is indicated, how it is done, risks and recovery

Surgery to remove the fibroid is indicated when a woman has symptoms such as severe abdominal pain and heavy menstruation, which do not improve with the use of medication, or when she has difficulty getting pregnant or infertility, due to the presence of the fibroid in the uterus. This surgery is usually not necessary when symptoms can be controlled with medication or when a woman enters menopause.

Fibroids are benign tumors that appear in the uterus in women of childbearing age, which cause intense discomfort such as menstrual bleeding and intense cramps, which are difficult to control. Medications can reduce its size and control symptoms, but when this does not happen, the gynecologist may suggest removing the fibroid through surgery.

The surgery to remove the fibroid, also called myomectomy, is performed by a gynecologist and is made available free of charge by the SUS, or can be performed in private hospitals, and the doctor must assess the woman’s interest in becoming pregnant because the surgery can bring future complications such as difficulty to become pregnant or need for a cesarean section, to reduce the risk of uterine rupture during labor.

When is it indicated

Myoma surgery is indicated when myoma symptoms are severe, in the following situations:

• Excessive vaginal bleeding, which does not improve with the use of medication;
• Longer menstrual period;
• Bleeding outside the menstrual period;
• Anemia, due to uterine bleeding;
• Chronic abdominal pain or abdominal bloating;
• Pain, discomfort or feeling of pressure in the pelvis;
• Need to urinate frequently;
• Chronic constipation.

Furthermore, fibroid surgery may be indicated in cases where a woman has difficulty getting pregnant or has infertility.

How it is made

Myomectomy is surgery performed to remove the fibroid from the uterus, and there are 3 different ways to perform myomectomy:

• Laparoscopic Myomectomy: small holes are made in the abdominal region, through which a microcamera and the instruments necessary to remove the fibroid pass. This procedure is only used in the case of myoma that is located on the external wall of the uterus;
• Miomectomia Abdominal: a type of “cesarean section”, where it is necessary to make a cut in the pelvis region, which goes to the uterus, allowing the removal of the fibroid. When a woman is very overweight, before undergoing abdominal surgery she must lose weight to reduce the risks of surgery;
• Hysteroscopic Myomectomy: the doctor introduces the hysteroscope through the vagina and removes the fibroid, without the need for cuts. Only recommended if the fibroid is located inside the uterus with a small part inside the endometrial cavity.

Normally, surgery to remove the fibroid manages to control the symptoms of pain and excessive bleeding in 80% of cases, however, in some women, the surgery may not be definitive, and a new fibroid appears in another location of the uterus, around 10 years later. . Therefore, the doctor often chooses to remove the uterus, instead of just removing the fibroid. Find out everything about removing the uterus.

The doctor may also choose to perform an endometrial ablation or embolize the arteries that are nourishing the fibroids, as long as it is a maximum of 8 cm or if the fibroid is on the posterior wall of the uterus, because this region has many blood vessels, and cannot be cut through surgery.

Read too: Embolization: what it is, what it is for, how it is done (and care)

What is recovery like from surgery?

Normally recovery is quick but the woman needs to rest for at least 1 week to heal properly, avoiding all types of physical exertion during this period. Sexual contact should only be done 40 days after surgery to avoid pain and infections. You should see a doctor if you experience symptoms such as a stronger smell from the vagina, vaginal discharge, and very intense, bright red bleeding.

Possible risks of surgery

The main risks of surgery to remove the fibroid are:

• Bleeding during surgery;
• Bleeding, which may require removal of the uterus;
• Scarring in the uterus, which can block the fallopian tube and make pregnancy difficult;
• Infection at the surgical site;
• Thromboembolism;
• Injuries to the bladder, intestine, ureter or blood vessels;
• Perforation of the uterus;
• Injuries to the cervix;
• Uterine rupture;
• Pulmonary edema;
• Edema cerebral.

These complications vary according to the type of surgery performed, and there may still be a risk of complications during pregnancy, especially if a deep cut was made in the wall of the uterus to remove the fibroid. prevent uterine rupture during labor.

When the surgery to remove the fibroid is performed by an experienced gynecologist, the woman can rest assured because the techniques are safe for health and the risks can be controlled.