Fibroid Surgery

What is Fibroid Surgery?

Fibroid surgery refers to procedures performed to remove uterine fibroids. Fibroids, also known as leiomyomas, are non-cancerous growths that develop in the muscular wall of the uterus. They are common during the reproductive years and may vary in size from very small nodules to large masses that distort the uterus.

Many fibroids cause no symptoms and do not require treatment. However, surgery may be recommended if fibroids lead to heavy menstrual bleeding, pelvic pain, pressure symptoms, fertility difficulties, or recurrent miscarriage.

Fibroid surgery aims to relieve symptoms, restore normal uterine anatomy, and, in some cases, improve fertility outcomes.

Who is Suitable for Fibroid Surgery?

Fibroid surgery may be suitable for women who experience significant symptoms or complications related to fibroids.

You may be considered for fibroid surgery if you have:

• Heavy menstrual bleeding: Causing anaemia, fatigue, or disruption to daily life
• Pelvic pain or pressure: Including lower abdominal discomfort or back pain
• Bladder or bowel symptoms: Such as frequent urination or constipation due to pressure
• Fertility concerns: Particularly when fibroids distort the uterine cavity
• Recurrent miscarriage: Linked to submucosal fibroid
• • Rapidly enlarging fibroids: Or uncertain diagnosis requiring further assessment

Women who have completed their family and have severe symptoms may consider more definitive surgery. Those wishing to preserve fertility are usually offered uterus-preserving procedures.

Benefits of Fibroid Surgery

Fibroid surgery can provide significant improvements in quality of life. The benefits depend on the type of surgery performed and the individual’s goals.

Potential benefits include:

• Reduction in heavy bleeding: Leading to improved iron levels and energy
• Relief of pelvic pain and pressure: Reducing discomfort and bloating
• Improved bladder and bowel function: When pressure symptoms resolve
• Restoration of normal uterine shape: Important for fertility
• Improved pregnancy outcomes: Particularly when cavity-distorting fibroids are removed
• Definitive symptom control: Especially after hysterectomy

For many women, surgical treatment offers long-term relief when medical therapies have failed or are unsuitable.

Types of Fibroid Surgery

The type of surgery depends on the size, number, and location of fibroids, as well as whether fertility preservation is desired.

Myomectomy

Myomectomy is the surgical removal of fibroids while preserving the uterus. It is commonly performed in women who wish to maintain fertility.

Types of myomectomy include:

• Hysteroscopic myomectomy: Used for submucosal fibroids inside the uterine cavity. A telescope is inserted through the vagina and cervix without abdominal incisions. Suitable for fibroids growing into the cavity.
• Laparoscopic myomectomy: A minimally invasive procedure using small abdominal incisions. Fibroids within or on the surface of the uterus are carefully removed, and the uterine wall is repaired. Dr Wong would refer you to a fibroid specialist for this surgery if required.
• Open (abdominal) myomectomy: Recommended for large, numerous, or deeply embedded fibroids. A larger incision is made in the lower abdomen. Dr Wong would refer you to a fibroid specialist for this if required.

Recovery time varies depending on the approach. Laparoscopic surgery generally offers faster recovery and less post-operative discomfort compared to open surgery.

Hysterectomy

Hysterectomy is the removal of the uterus and is considered a definitive treatment for fibroids. It eliminates the possibility of recurrence. Dr Wong would refer you to a hysterectomy specialist if required.

It may be recommended for:

• Women with severe symptoms
• Women who do not wish to have children
• Very large or multiple fibroids

Hysterectomy can be performed:

• Vaginally
• Laparoscopically
• Abdominally

The ovaries may or may not be removed depending on age and individual circumstances.

Alternative Options to Fibroid Surgery

Not all fibroids require surgery. Several non-surgical or less invasive options may be considered depending on symptoms and personal preferences.

Medical Management

Medications may help control symptoms, but do not permanently remove fibroids.

Options include:

• Hormonal contraception: Helps regulate heavy bleeding
• Progesterone therapies: Such as intrauterine devices
• Tranexamic acid: Reduces menstrual blood loss
• GnRH analogues: Temporarily shrink fibroids before surgery

Medical treatment is often suitable for women with mild symptoms or those approaching menopause.

Uterine Artery Embolisation (UAE)

Uterine artery embolisation is a minimally invasive radiological procedure. Tiny particles are injected into the uterine arteries to block blood flow to fibroids, causing them to shrink.

It may be suitable for women:

• With significant symptoms
• Who wish to avoid major surgery
• Who do not prioritise future fertility

Fertility outcomes after UAE are less predictable than after myomectomy.

MRI-Guided Focused Ultrasound

This non-invasive treatment uses high-intensity ultrasound waves to destroy fibroid tissue. It is not suitable for all fibroid types and may be limited in availability.

Watchful Waiting

If fibroids are small and not causing symptoms, regular monitoring may be appropriate. Many fibroids shrink naturally after menopause due to hormonal changes.

What to do Before a Fibroid Surgery?

A thorough assessment ensures the safest possible outcome.

Before surgery, you may require:

• Pelvic ultrasound or MRI: To assess the size, number and location of fibroids
• Blood tests: To check iron levels, haemoglobin and overall health
• Anaesthetic review: Particularly if you have medical conditions
• Pregnancy test: If relevant
• Discussion of fertility goals: To determine the most appropriate surgical approach

If you have heavy bleeding and anaemia, iron supplements or iron infusion may be recommended before surgery to improve recovery.

Medications may need adjustment:

• Stop blood-thinning medications: If advised by your doctor
• Hormonal therapy: Sometimes prescribed before surgery to shrink fibroids and reduce bleeding
• Fasting: Usually required for 6–8 hours before general anaesthesia

You should also:

• Arrange time off work
• Organise help at home, especially if undergoing open surgery
• Avoid smoking, as this increases surgical risks
• Follow all hospital admission instructions carefully

Clear communication with your specialist helps reduce anxiety and ensures that you understand the procedure, recovery expectations, and potential risks.

Fibroid Surgery Procedure

The procedure varies depending on whether you are having a myomectomy (removal of fibroids only) or a hysterectomy (removal of the uterus).

Most fibroid surgeries are performed under general anaesthesia.

Hysteroscopic Myomectomy

• A telescope is inserted through the vagina and cervix
• No abdominal incisions are required
• Submucosal fibroids inside the uterine cavity are shaved away
• The procedure usually takes 30–60 minutes

This is typically a day procedure.

Laparoscopic Myomectomy

• Small incisions are made in the abdomen
• A camera and fine surgical instruments are inserted
• Fibroids are carefully removed from the uterine wall
• The uterus is repaired with sutures

This minimally invasive approach usually allows shorter hospital stays and faster recovery.

Open (Abdominal) Myomectomy

• A larger incision is made in the lower abdomen
• Fibroids are removed directly
• The uterus is reconstructed

This is recommended for very large or multiple fibroids.

Hysterectomy

If a hysterectomy is performed:

• The uterus is removed
• The cervix and ovaries may or may not be removed depending on your age and medical history

Surgery duration varies from 1 to 3 hours, depending on complexity.

What to Expect After a Fibroid Surgery?

Recovery depends on the surgical approach.

After Hysteroscopic Surgery

• Mild cramping for a few days
• Light vaginal bleeding
• Return to normal activities within a few days

After Laparoscopic Surgery

• Mild to moderate abdominal discomfort
• Shoulder tip pain (from surgical gas)
• Small scars
• Return to light activities within 1–2 weeks
• Full recovery in 2–4 weeks

After Open Surgery

• More noticeable pain and fatigue
• Hospital stay of 2–4 days
• Larger abdominal scar
• Recovery period of 4–6 weeks

General post-operative expectations:

• Temporary bloating
• Fatigue
• Gradual improvement in symptoms
• Follow-up appointment within a few weeks

If fertility is desired, your specialist will advise how long to wait before attempting pregnancy. After myomectomy, this is often around 3–6 months to allow the uterus to heal.

Fibroid Surgery Prognosis

The outlook after fibroid surgery is generally very good.

• Symptom relief: Most women experience significant improvement in bleeding and pain
• Improved quality of life: Energy levels often improve once heavy bleeding resolves
• Fertility outcomes: Many women successfully conceive after myomectomy, particularly when cavity-distorting fibroids are removed
•  Low recurrence risk after hysterectomy: Fibroids cannot return once the uterus is removed

However, fibroids can recur after myomectomy, particularly in younger women. Recurrence rates vary but may range between 15–30% over several years.

Long-term outcomes depend on age, number of fibroids removed, and hormonal factors.

Fibroid Surgery Risks

All surgery carries some risk. Serious complications are uncommon but can occur.

General surgical risks include:

• Bleeding: Occasionally requiring transfusion
• Infection: Of the wound or uterus
• Damage to surrounding organs: Such as bladder or bowel
• Blood clots: In the legs or lungs
• Anaesthetic complications: Rare but possible

Specific risks of myomectomy:

• Scar tissue (adhesions): May affect fertility
• Uterine weakening: In rare cases, future pregnancy may require caesarean section
• Fibroid recurrence: Possible over time

Specific risks of hysterectomy:

• Early menopause: If ovaries are removed
• Emotional impact: Particularly for women who had hoped for a future pregnancy

Careful surgical planning and experienced specialists significantly reduce complication risks.

What if Fibroid Surgery is Delayed?

In some cases, delaying surgery is reasonable, particularly if symptoms are mild. However, postponing treatment may lead to:

• Worsening heavy bleeding 
• Increasing fibroid size
• Pressure symptoms
• Fertility difficulties
• Chronic pelvic discomfort

For women approaching menopause, fibroids may naturally shrink as hormone levels decline. In these cases, careful monitoring may be appropriate.

If fertility is a priority, delaying treatment for cavity-distorting fibroids may reduce chances of conception or increase miscarriage risk.