Hysteroscopic Myomectomy / Polypectomy
A hysteroscopic myomectomy or polypectomy is a procedure your doctor may perform if you have abnormal bleeding patterns that may or may not be accompanied by infertility issues as well. Broken down:
- A hysteroscopy is the process of looking into your uterus with a telescopic instrument called a hysteroscope.
- Myomectomy is another term for laparotomy. It refers to a minimally invasive procedure used to remove fibroids from your uterus.
- Polypectomy is what occurs when the hysteroscopy reveals that you have uterine polyps.
Whether you have a myomectomy vs hysterectomy will result in very different outcomes. The myomectomy removes only fibroids; your uterus remains entirely intact. During a hysterectomy, your reproductive organs are removed, often including your fallopian tubes, ovaries and all or part of your womb. One of the main reasons to get a hysteroscopic myomectomy/polypectomy is to determine which procedure you need.
You may be a candidate for hysteroscopic myomectomy/polypectomy — and at risk for uterine polyps or fibroids that lead to abnormal bleeding — if your symptoms don’t respond to more conservative treatments. Other reasons to undergo the procedure include if you:
- Are on tamoxifen therapy for breast cancer treatment
- Have had polyps in other reproductive organs
- Have chronic bleeding following sex
- Experience continuous, chronic vaginal discharges
- Have dysmenorrhea or abnormally painful menstrual cycles
- May have polyps that are preventing you from getting pregnant
How to Prepare for the Test
While the procedure is minimally invasive, you may be put under general anesthesia for abdominal, robotic, laparoscopic and for other types of hysteroscopic myomectomies. Conversely, you may just receive a localized spinal anesthetic that numbs the lower half of your body. This is recommended for certain hysteroscopic myomectomies.
If your doctor decides on general anesthesia, you can expect to be out for about 15 to 30 minutes. You’ll be asked to stop eating the night before your procedure; make sure you follow directions for the length of time your doctor prefers. Additionally, tell your doctor about any medications you may be taking, including herbs, supplements and other over-the-counter medications, such as vitamins and pain relievers. You’ll most likely need to discontinue their use until after the procedure.
While a hysteroscopic myomectomy/polypectomy is typically performed on an outpatient basis, you may have to be hospitalized for the procedure.
- An open myomectomy, performed through your abdominal cavity, usually requires a two-to-three-day hospital stay.
- A robotic myomectomy or one done with a laparoscopic usually requires just an overnight stay.
What to Expect from Vaginal Myomectomy
Once you’ve been prepped and moved into a surgical suite in the doctor’s office or hospital:
- Your cervix is dilated with a sterile saline solution to expand the area and give the surgeon room to visually inspect your reproductive organs.
- Tissue is cut, usually with a laser through your vagina and your uterus into the cervix, to retract it appropriately.
- Pieces of the fibroids are shaved off so that they don’t protrude and are even with the rest of the tissue lining your cervix.
- Polyps are completely removed, with a sharp pincer-type instrument attached to a long, thin, lighted tube. The area may be lightly cauterized to stop any bleeding.
- Robotic arms, guided by the doctor watching through a camera that’s inserted through the same opening, may do all the actual procedures.
- Once the instruments are removed, your cervix is lightly rinsed with the fluid that was used to expand your cervix. With it, excess tissues from the fibroids are washed out.
Once you leave the office or hospital, you’ll be provided a mild pain reliever. Follow the directions for after-care that you receive, such as:
- Resume normal eating habits immediately
- Avoid tampon use for at least two or three days
- Refuse sexual intercourse until all the bleeding has stopped completely
- Only take showers, no baths, until the bleeding has completely stopped
- Use a hot water bottle or pain medication when you feel uncomfortable cramping, which is to be expected for a few days
- Plan to avoid driving for at least 24 hours
- Get back into your normal daily routines as soon as you feel able, unless your doctor advises you otherwise
Hysteroscopic Myomectomy Complications
It’s important that your gynecological surgeon remove all polyps found because those tend to be the culprits that lead to cancer. Removing benign polyps is an important step in allaying any signs of cancer early on.
Complications from the procedure are rare, but they do exist. Some potential aside effects of myomectomy/polypectomy include:
- Excessive bleeding after the procedure. This may be particularly prevalent if the reason for the procedure in the first place was heavy bleeding. While your doctor takes extra precautions to prevent excess bleeding, you may be directed to take steps to build your blood count up before the procedure.
- A hysteroscopic myomectomy may affect a future pregnancy if your uterine walls are weakened by any incisions made during the procedure. You may have to undergo a caesarian section or C-section to avoid further complications. Additionally, the very presence of uterine fibroids is often associated with complications during pregnancy.
- Scar tissue sometimes forms in the spots where incisions were made. Scar tissue forming outside the uterus can lead to a blocked fallopian tube or problems with your intestines becoming looped. Adhesions rarely form inside the uterus, but if they do, you could develop Asherman’s syndrome, which causes infertility.
- Hysterectomy is another extremely rare complication. It results from a finding of severe abnormalities in your uterus or if bleeding becomes uncontrollable while you are having the procedure done.
- Cancerous tumors can be spread during this procedure, although this too is a rare complication. It’s more common in post-menopausal women. It’s caused by tumors being mistaken for fibroids and being shaved into little pieces that then travel through your body and multiply.
The results from a hysteroscopic myomectomy/polypectomy can lead to drastic improvements in your life. At the same time, once you’ve had fibroids or polyps, you are at a greater risk of getting them again. And your doctor could miss really tiny tumors that eventually grow, cause you symptoms that require another procedure. But immediate benefits include:
- Improved fertility. While your chances of a post-hysteroscopic myomectomy pregnancy are greatly improved, you should wait about three months before trying to get pregnant to give your uterus sufficient time to heal properly.
- Relief from the symptoms that instigated the procedure in the first place, such as excessive bleeding that finally comes under control.
All symptoms should always be evaluated with a thorough consultation and examination by your gynecologist for an accurate diagnosis and treatment plan to exclude any underlying serious condition. The hysteroscopic myomectomy procedure, indications, options, risks/benefits should always be discussed with your gynecologist.
Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult ob/gyn doctor about your specific condition. Only a trained, experienced board certified gynecologist can determine an accurate diagnosis and proper treatment.
Do you have questions about Hysteroscopic Myomectomy / Polypectomy procedure? Would like to schedule an appointment with an internationally recognized NYC OBGYN doctor, Dr. Pedram Bral of Manhattan Women’s Health and Wellness, please contact our office for OBGYN consultation.consultation.
Dr. Pedram Bral, Gynecologist (Gynecologist NYC, Midtown)
New York, NY10010
(Between Madison Ave & Park Ave)
☎ (212) 533-4575