Myomectomy – The Fibroid Surgery African Women Need to Know

By Udochukwu Glory Maduka, MB.BS.  Medically reviewed by: Azuka Ezeike, MB.BS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc. (Public Health).

A young Afro woman wearing eyeglasses and a beige t-shirt, in apparent pain and holding on to her abdomen. Chronic pain in the lower belly is one of the reasons for myomectomy in women who are known to have fibroids. Image credit: Freepik

 

Highlights

• Fibroids affect up to 70–80% of black women during their reproductive years.

• Myomectomy is a surgical option to remove fibroids while retaining the uterus.

• The different types of myomectomy include abdominal (open), laparoscopic (pin hole), and hysteroscopic (no incision) myomectomy techniques.

• Preparation, surgery and recovery planning for myomectomy include pre-surgery imaging, medication guidance, anaesthesia types, blood donation, surgical and hospital stay expectations, recovery timelines, and follow-up care.

• Risks and long-term potential complications may include bleeding, infection, and scarring  

• The likelihood of fibroid recurrence is moderate to high after myomectomy.

 

Introduction

Fibroids are one of the most common health concerns among African women, especially those in the reproductive age (between 25 and 45 years).

They are abnormal growths, usually non-cancerous (benign), that arise in the muscles of the uterus (womb).

They come in different sizes- the small and large ones. And can present with some symptoms, such as heavy menstrual bleeding, etc. depending on the location. 

Black women face the highest risk of this condition, with rates 3 to 4 times higher than women of other races. It is estimated that 70 to 80% of black women will develop fibroids in their lifetime. [1]

Myomectomy (surgical removal of fibroids) offers a solution that removes the fibroids while preserving the uterus for women who want to bear children. 

In this guide, we’ll explain who needs this surgery, how to prepare for it, what to expect during and after the procedure, and possible risks.

 

What Is a Myomectomy?

Myomectomy is a type of surgery done to remove fibroids from the uterus (also known as the womb) while preserving the tissues of the uterus to enable the woman to still get pregnant after the surgery.

It is different from a hysterectomy, which is a surgery done to completely remove the uterus (womb), in which case, the woman can no longer carry a pregnancy. 

There are three types of myomectomy 

1. Abdominal or open myomectomy 
2. Laparoscopic myomectomy 
3. Hysteroscopic myomectomy 

Abdominal myomectomy

Fig. 2: Showing composite illustration of Pfannenstiel (bikini) incision in the lower abdomen of a woman (L) and multiple uterine fibroids from an open myomectomy.(R). Click on image to enlarge.

 

Abdominal myomectomy is also known as open myomectomy (see fig. 2). It is usually used to remove fibroids (leiomyomas) of any size, but typically large ones that are located in the muscle and underneath the outer walls of the uterus and causing several complications (see fig. 1). 

The surgery involves the following steps: [2]

• The anaesthetist (a special doctor) puts you to sleep, keeps you safe, comfortable and pain free by using a process called general anaesthesia (GA). Other forms of anaesthesia that may be used does not put you to sleep but will make you pain free during the surgery. 
• Your gynaecological surgeon then makes a horizontal cut (surgical incision) in the lower part of your abdomen called a Pfannenstiel incision (bikini cut) or a central vertical cut from below your umbilicus (belly button) to the top of your pelvic bone
• Your uterus is exposed and isolated
• Your fibroid or fibroids are located and removed.
• Your wounds, both in the uterus and abdominal wall are stitched back and the operation is completed.
• When you wake up, you are taken into a special recovery room to be watched post-surgery for some time before you are returned to your hospital room or ward.

Short term recovery takes 3 to 5 days in the hospital and 4 to 6 weeks to return to work.

Laparoscopic Myomectomy

Fig. 3: Illustration of a typical operating scene during laparoscopic myomectomy. Image credit.

 

This type of myomectomy may be right for you if you have a few and small-sized fibroids that are located beneath the outer covering of the uterus (see fig 1). In well experienced hands, laparoscopic myomectomy may be used to remove large fibroids too. [3, 4] The fibroids are removed through small cuts in your abdominal (belly) wall in a procedure that is identified as minimally invasive surgery. The surgical procedure involves the following steps: [2]

• Once you are under GA, your surgeon makes small (pin-hole) incisions in your abdominal wall and inserts special instruments through the incisions into an area deep down your lower abdomen called the pelvis (see fig. 3).
• Air is passed into your belly through one of the instruments to blow up your belly and allow your surgeon to see clearly.
• A flexible instrument with a tiny camera and light at its end (laparoscope) is inserted through another incision. 
• Another instrument is inserted through yet another incision for purposes of cutting the fibroid when identified.
• All the instruments enable your surgeon to see inside your abdomen, while the fibroids in your uterus (womb) are located, carefully cut (dissected) and removed. 
• Any bleeding caused during the surgery is controlled before all the instruments are removed, and your abdominal incisions are closed.
• Sometimes, if your fibroid is large, your surgeon may cut it into smaller pieces to take them out through these small openings. 

Compared to open myomectomy, laparoscopic myomectomy causes less bleeding, has fewer complications, and leaves less scar tissue. You will recover in the hospital faster—typically in 1 to 2 days. [4]

Hysteroscopic Myomectomy

Fig 4: Cartoon illustration of a hysteroscopic myomectomy. Click on imge to enlarge. Image credit

 

This procedure is another minimally invasive surgery for removal of fibroids. It is best suited for the removal of a fibroid that grows into the cavity of the uterus (womb). This type of fibroid is called submucosal fibroid (see fig. 1). It does not require any incision on the abdominal wall. The procedure involves: [2]

• Being put to sleep and made safe, comfortable and pain free under GA
• Your surgeon performing dilatation (opening up) of the cervix to allow for the passage of instruments to be used later
• A clear liquid is often gently injected into the inside of the uterus to help it expand, making it easier for the surgeon to see everything clearly.
• Your surgeon passing a flexible instrument with a camera and light at its end (hysteroscope) through your vagina into the uterus (womb) to check the location and other features of the fibroid to be removed
• Removal of the hysteroscope and insertion of  another special instrument (resectoscope) through the cervix to dissect (cut) and remove any intracavity fibroid identified (see fig. 4)

Hysteroscopic myomectomy is a day procedure, and you can go home after full recovery from the GA.  

 

Who Needs a Myomectomy?

Fig. 5: Indications for myomectomy. Click on image to enlarge.

 

Myomectomy is usually recommended for those who have symptomatic fibroids and still want to preserve their womb, maybe for childbirth (see fig. 5). Symptomatic fibroids are fibroids that are causing noticeable symptoms, such as: 

• Heavy Menstrual Bleeding with Clots
• Prolonged Menstruation 
• Pelvic pains
• Frequent urination or difficulty urinating.
• Recurrent loss of pregnancy
• Not able to get pregnant 

 

How to Prepare for Myomectomy

1. Meet your doctor and ask questions 

When meeting with your doctor to discuss the surgery, take the opportunity to ask any questions you may have about preparation and what you can expect throughout the process.

2. Do the recommended tests.

Your doctor will likely recommend imaging tests, such as an ultrasound or Magnetic Resonance Imaging (MRI), to effectively determine the location, size, and number of fibroids. 

Blood tests will also be beneficial in assessing anaemia, ensuring proper clotting, and evaluating your overall health.

3. Arrange for blood donation

Arrange to make blood available. This is because myomectomy may be associated with blood loss that could require transfusion. Your husband or any relative can donate. The amount of blood needed is determined by your doctor.

4. Sign the Informed Consent Form

Your doctor will further explain the surgery and give you an informed consent form to sign. Be sure to read the form carefully, ask questions on any content of the form that you do not understand or are unsure about before signing it. You can also ask your husband or a family member to read and sign the form on your behalf.

5. Use of medications and adjustments

In preparation for the surgery, it’s important to share all medications you currently take, including vitamins and supplements, with your doctor, as some may need to be paused before your myomectomy. [5]

6. Lifestyle adjustments 

If you smoke, try to quit six to eight weeks before your surgery. This can help you heal better and decrease your risk of heart problems. Your doctor can support you in this effort.

7. Food adjustments 

You will stop eating and drinking after 10 pm before your surgery to ensure the best possible outcome.

 

What Happens During Myomectomy Surgery?

Before the surgery starts, you will be given anaesthesia so you won’t feel pain.

The type of anaesthesia depends on the type of myomectomy. It may be general, spinal, epidural, or a mix of spinal and epidural types called Combined Spinal Epidural (CSE). [4]

1. General Anaesthesia: 

This puts you into a deep sleep during surgery, with a tube placed in your throat for breathing. Commonly used for laparoscopic, robotic, and abdominal myomectomies, and sometimes for hysteroscopic myomectomies.

2. Spinal Anaesthesia: 

A single injection into the spinal fluid so you stop feeling your lower body.  It is sometimes used for abdominal myomectomies and can be combined with epidural anaesthesia.

3. Epidural Anaesthesia: 

A catheter is placed near the spinal cord (in the epidural space) to deliver pain medication, providing relief during and after abdominal myomectomies.

4. Combined Spinal Epidural (CSE) Anaesthesia  

It merges spinal and epidural techniques for quick pain relief and prolonged comfort.

5. Monitored Anaesthesia Care

This helps you relax and feel drowsy without using a breathing tube. The anesthesiologist stays with you during a procedure, continuously monitoring vital signs (like heart rate, breathing, blood pressure, oxygen levels) and adjusting medications as needed. It is often used for less invasive procedures like hysteroscopic myomectomies.

After you have received anaesthesia, the surgeon will make a careful incision based on the chosen surgical method. 

The fibroids will be removed, and your uterus will be properly sutured back afterwards depending on the type of myomectomy performed.

Sometimes, a drainage tube is passed from inside your abdomen to the outside to help drain fluids (blood) accumulating inside after the closure depending on the surgeon and extent of surgery. 

The whole procedure usually takes about 1 to 3 hours, depending on how many fibroids there are and their size.

 

What to Expect Immediately After Myomectomy Surgery

• Hospital Stay: Depends on the type of myomectomy. For abdominal myomectomy, it can last up to 3-5 days in our environment. Laparoscopic or hysteroscopic myomectomy is usually a one-day procedure. [4]

• Pain and discomfort: You can experience pain and discomfort, which is normal, so painkillers will be provided.

• Bleeding: There may be light vaginal bleeding for a few days is common.

• Removal of drainage tube: This is usually removed after 2 days once it stops actively draining.

• Early Movement: You’ll be encouraged to walk around soon to prevent clots.

• Restrictions on some activities: Try to avoid heavy lifting, intense workouts, and sexual activity for at least 4 to 6 weeks to give your body time to heal.

• Nourishment and Hydration: Eat a balanced diet with fruits, veggies, lean proteins, and whole grains to support healing. Remember to drink a lot of water to help prevent constipation.

 

Long-Term Recovery and Expectations after Myomectomy

• Full Recovery

Expect a recovery period of 4 to 6 weeks for open surgery and 2 to 4 weeks for minimally invasive surgery.

• Pregnancy after Myomectomy 

You can conceive after undergoing myomectomy, but doctors usually recommend waiting 3 to 6 months before attempting to get pregnant.

• Follow-Up Care

Fibroids can sometimes regrow, so regular follow-up care is essential.

 

Possible Risks and Complications of Myomectomy:

• Bleeding: Some bleeding may occur during or after surgery, which may require a blood transfusion to stabilise blood volume and pressure.

• Recurrence: New fibroids can grow back and this might require another myomectomy or hysterectomy if it keeps growing back. 

• Infection: There’s a slight chance of infection at the surgery site, but don’t worry! It is usually easily treated with antibiotics. In rare cases where it's more severe, an additional surgery may be needed.

• Scar tissue formation: After surgery, the uterine walls can stick together and form scars causing a condition known as uterine synaechiae. This can sometimes cause pain and can prevent fertility. It might require another surgery to separate them. 

• Organ damage: The uterus may be perforated (especially during hysteroscopic myomectomy). Other abdominal organs like the bladder and bowel may rarely be damaged. Urinary tract infection and brief post-operative fever are common and readily managed.

• Emergency Hysterectomy: In rare cases, uncontrolled bleeding may necessitate an emergency hysterectomy to prevent serious complications.

Taking care of yourself after surgery can help reduce these risks.

 

Conclusion

Myomectomy is a safe and effective way to treat fibroids while preserving fertility. If you have fibroid-related symptoms that are affecting your quality of life, talk to your gynaecologist about whether this procedure is right for you.

 

FAQs about Myomectomy

Can I get pregnasnt after myomectomy?

Yes, many women go on to have successful pregnancies after the surgery.

Will my fibroids come back?

They can, especially in younger women, but recurrence rates vary.

Is myomectomy safer than hysterectomy?

It’s generally considered safer for women who want to still have children after the surgery, but every case is different.

How soon can I return to work?

Light office work can resume in 2–4 weeks for minimally invasive surgery; 4–6 weeks for open surgery.

 

References

1. Igboeli P, Walker W, McHugh A, Sultan A, Al-Hendy A. Burden of Uterine Fibroids: An African Perspective, A Call for Action and Opportunity for Intervention. Curr Opin Gynecol Obstet. 2019;2(1):287-294. doi: 10.18314/cogo.v2i1.1701. Available from here.

2. UCSF Health. Myomectomy [Internet, n.d.]. San Francisco (CA): UCSF Health; [cited 2025 Aug 22]. Available here.

3. Asaolu OA, Ejenobo DTE; Alabi OA. Laparoscopic Myomectomy for Huge Uterine Fibroid in Sub-Saharan Africa: A Case Report. African Journal of Reproduction and Gynaecological Endoscopy 2023;8(1):p 32-36. doi: 10.4103/ajrge.ajrge_9_23. Available from here.

4. Barjon K, Kahn J, Singh M. Uterine Leiomyomata. [Updated 2025 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. [Cited August 29, 2025] Available from:here. 
 

Related: Fibroid; What Every African Woman Should Know

 

Published: August 30, 2025

© 2025. Datelinehealth Africa Inc. All rights reserved.

Permission is given to copy, use and share content without alteration or modification and subject to source attribution.