Overview of Fibroids Removal

Uterine fibroids are benign (not cancerous) growths in the uterine wall. They can appear as a single fibroid or as a cluster, and can range in size from smaller than the head of a pin to bigger than a watermelon.

Fibroids—also referred to as leiomyomas—are fairly common. They affect up to 80% of people with uteruses by 50 years of age.

In 20% to 50% of cases, fibroids cause symptoms and may require treatment.

When fibroids require treatment, there are factors to consider, including:

• Age
• General health
• What symptoms exist and how severe are they?
• Type, number, and location of fibroids
• Current or future pregnancies

The degree to which the symptoms are affecting the quality of life also plays a large role in whether or not fibroid removal is explored and which treatment is chosen.

This article discusses fibroid removal options you can explore with your healthcare provider.

When Fibroids Removal Is Necessary

The biggest consideration for whether or not fibroids should be removed is if they are causing disruptive symptoms.

Some other things to explore in conversation between the person with fibroids and their healthcare provider include:

• What symptoms, if any, are present?
• How many fibroids are there?
• How big are the fibroids?
• Where are the fibroids located?
• Are the fibroids likely to grow larger?
• How fast have they grown since the last exam (if applicable)?
• What are some ways to know the fibroids are growing larger?
• In what ways are the fibroids affecting regular life and activities?
• What problems can the fibroids cause?
• What tests or imaging studies are best for keeping track of fibroid growth?
• What are the options for treatment if needed?
• What are the risks and benefits of removing the fibroids or leaving them intact?
• What are the risks and benefits of each treatment?

The healthcare provider may run imaging tests to get a better view of the fibroids, the pelvis, and the abdomen.

These might include:

• Ultrasound: An ultrasound probe placed on the abdomen or inside the vagina uses sound waves to produce a picture
• Magnetic resonance imaging (MRI): Creates a picture using magnets and radio waves
• X-rays: Uses a form of radiation to produce a picture of inside the body
• Cat scan (CT): A more complete image is created by taking many X-ray pictures of the body from different angles
• Hysterosalpingogram (HSG): Involves injecting dye into the uterus and doing X-rays
• Sonohysterogram: Involves injecting water into the uterus and doing an ultrasound

Occasionally, surgery may be performed to make a conclusive diagnosis of fibroids. Most commonly, one of the following will be done:

• Laparoscopy: A long, thin scope (a bright light and camera) that is inserted into a tiny incision made in or near the navel (belly button) projects images of the uterus and other organs onto a monitor during the procedure. Pictures may be taken.
• Hysteroscopy: A long, thin scope with a light (and sometimes camera) is inserted through the vagina and cervix into the uterus, allowing the healthcare provider to explore inside the uterus without making an incision.

Types of Procedures

Fibroids are "removed" in several ways:

• Surgically taken out of the body
• Caused to shrink
• Destroyed

Which one is chosen depends on a number of factors including personal preference, but they all get rid of or greatly reduce the size of fibroids.

Surgeries

Two main surgeries are used to remove fibroids.

Myomectomy

A myomectomy removes the fibroids but leaves the uterus intact.

The uterus usually returns to functioning normally after a myomectomy, including menstruation, which may be lighter than it was presurgery.

While pregnancy is possible after a myomectomy, the pregnancy may need to be monitored for possible risks if the fibroids were deeply embedded and/or if any spanned a large part of the uterine wall.

There are three main types of myomectomy:

• Open myomectomy: Invasive, uses a vertical or horizontal incision, done under general anesthesia, takes up to six weeks to recover.
• Minimally invasive laparoscopic myomectomy: Uses several small incisions or one slightly bigger incision; inserts a small, lighted telescope and special tools to remove the fibroids; performed under general anesthesia; recovery time is about a week.
• Hysteroscopic myomectomy: Requires no incisions, a camera with a specialized attachment is placed through the vagina into the uterus to remove fibroids; performed under general or regional anesthesia; recovery time is about a week.

Hysterectomy

During a hysterectomy, the uterus is removed. Sometimes the cervix, one or both ovaries, and/or the fallopian tubes are also removed.

A hysterectomy can be done via open abdominal surgery, or the less invasive options of vaginal, laparoscopic, or robotic approaches.

This procedure might be recommended if very heavy bleeding is present or if the fibroids are very large.

If the ovaries are left in place, menopause will not be triggered by a hysterectomy. If the ovaries are removed, menopause will begin immediately.

A hysterectomy is the only way to ensure fibroids are removed permanently. The fibroids and their symptoms end and do not regenerate.

A hysterectomy is a major surgery under a general anesthetic. It takes up to eight weeks to recover from, depending on the method used and carries the risks that come with major surgery.

The National Institute for Health and Care Excellence (NICE) recommends that hysterectomy should be considered only when:

• Other treatments have been unsuccessful or are unable to be conducted
• The person with fibroids wants to stop menstruating
• The person with fibroids requests the procedure after being fully informed about the surgery and the risks involved

Other Procedures

MRI-Guided Focused Ultrasound Surgery (MRgFUS)

This noninvasive procedure uses high-intensity ultrasound waves to generate heat and destroy fibroids.

MRgFUS uses a device called the Exablate, which combines magnetic resonance imaging (MRI) with ultrasound.

The procedure takes about three hours, during which the person lies inside an MRI machine. They are conscious, but are given a mild sedative.

The radiologist uses the MRI to target the fibroid tissue, direct the ultrasound beam, and to help monitor the temperature generated by the ultrasound.

Uterine Artery Embolization (UAE)

This procedure, also called uterine fibroid embolization (UFE), shrinks fibroids by cutting off their blood supply.

A catheter is placed through a small incision in the groin and threaded into the uterine artery. Small plastic particles (about the size of grains of sand) are then injected into the artery to block the blood supply to the tiny arteries that feed fibroid cells.

During the 60- to 90-minute procedure, the person remains conscious, but is sedated.

Most people return home the same day and return to normal activities within one week.

Radiofrequency Ablation

This is a minimally invasive laparoscopic procedure.

Using heat generated by high energy waves, this procedure destroys fibroids.

An ultrasound is to verify the correct placement of the radiofrequency device within each fibroid before the fibroids are destroyed.

It is usually performed as an outpatient procedure and is considered a safe and relatively low risk alternative to hysterectomy.

It can be also be delivered by transvaginal (across or through the vagina) or transcervical (through the cervix) approaches.

Endometrial Ablation

This procedure destroys the endometrium (the lining of the uterus) using some form of heat (radiofrequency, heated fluid, microwaves).

It is typically used to stop heavy menstrual bleeding, but it can also be used to treat small fibroids.

It is not used for large fibroids or for fibroids that have grown outside of the interior uterine lining.

Endometrial ablation usually stops monthly menstruation, or for some significantly reduces it.

It is usually done as an outpatient procedure and can take as little as 10 minutes to complete.

Recovery typically takes a few days, but it is normal for watery or bloody discharge to last for several weeks.

It significantly decreases the likelihood of pregnancy, but it increases the risks of complications (such as miscarriage or ectopic pregnancy) if pregnancy does occur. People who choose this procedure must take steps to prevent pregnancy.

This procedure may delay or make it more difficult to diagnose uterine cancer in the future.

People who have this procedure should continue to have recommended pap smears and pelvic exams.

Benefits and Risks

Frequently Asked Questions

When can you have sex after fibroids removal?

Because the procedures vary and so do their recovery times, when you can have sex varies too. For instance, UAE may only need one or two weeks while a hysterectomy can take six weeks or more.

It's best to speak to your healthcare provider before resuming sex.

How long does it take to heal after fibroids removal?

Recovery time depends on the procedure used. For some, like endometrial ablation, recovery time is as little as a few days. For others, like some forms of myomectomy, it can take eight weeks or more to fully recover.

How long after fibroids removal can you have IVF?

Best practice is to delay pregnancy by any means of conception for at least three months after fibroid removal.

IVF can be done at this three-month mark.

A Word From Verywell

Fibroids are rarely dangerous, but they can cause symptoms that interfere with your quality of life.

When symptoms become bothersome enough to prompt the removal of fibroids, several options are available with varying degrees of invasiveness and efficacy. Which option to choose depends on you and your fibroids.

If you have fibroids or symptoms of fibroids, talk with your healthcare provider about your options.