Myomectomy
Definition
Myomectomy is the surgical removal of myomas of the uterus (fibroids).
Description
Uterine fibroids, technically called leiomyomata but also called fibromyomas or myomas, are benign growths in the uterus. Fibroids are thought to arise from the growth and division of a single muscle cell that develops within the muscular wall of the uterus, the myometrium. Fibroids may occur singly but are typically multiple in number. Although they start off within the wall of the uterus (intramural), they can grow toward the inside of the lining of the uterus (submucosal) or toward the surface (subserosal). If they grow away from the surface, they may develop a stalk, a pedunculated fibroid. They can range in size from small, pea-size lumps to very large masses (eight to ten inches or larger in diameter), which distort the uterus, making it large, bulky, and irregular in contour. The growth of fibroids is unpredictable. They may remain relatively stable, or they may increase in size rapidly.
Causes
It is not well known what causes fibroids, although there may be some familial tendency to develop them. There does appear to be a link with the female hormone estrogen, as fibroids may increase in size during pregnancy, when estrogen levels are high, and decrease in size after menopause when estrogen levels are low.
Symptoms
The majority of women with fibroids (up to 80 percent) have no symptoms. If symptoms do occur, they may include a heavier menstrual flow or one of longer duration, increased menstrual cramping and backache, irregular or unpredictable bleeding, and lower-abdominal pressure, which is often described as an achy or heavy feeling, or which may be associated with the need to urinate more frequently.
Questions
Which method, a myomectomy or a hysterectomy, would be the better treatment? What type of myomectomy would you recommend? What kind of results can be expected with a myomectomy? If the myomectomy is elected, will you be recommending a hormone treatment before surgery? If so, what type of side effects will there be? How painful is a myomectomy? How long will the hospital stay be?
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