Questions to Ask Before a Myomectomy
For patients with fibroids who have been offered a myomectomy, the operation that takes the fibroids out and leaves the uterus in place. The questions are grouped the way the talk with the surgeon tends to go: the case for this operation over the other fibroid treatments, the approach, bleeding and the hysterectomy line on the consent form, pregnancy and birth afterwards, then recovery and whether fibroids return. It is a list for that conversation and not medical advice, and anything about cost, leave or consent paperwork depends on where you are treated.
The questions
Each question, and why to ask it
The decision
What is it about my fibroids that makes a myomectomy the right operation for me?
Why ask it
The reply should mention where your fibroids sit, how many there are, which symptoms they are blamed for and whether you want to keep pregnancy possible. If it would fit anyone with fibroids, ask what on your own scan points to this operation.
What are the alternatives for fibroids like mine: medication, embolization, ablation, hysterectomy, or watching and waiting?
Why ask it
Take the options one at a time and get a reason for or against each. Some depend on the size and position of the fibroids, and some are approached with caution when a pregnancy is wanted. If one is ruled out only because this hospital does not offer it, find out who does.
Which of my symptoms do you expect to improve once the fibroids are out, and which may have another cause?
Why ask it
Say them out loud in turn: the bleeding, the pressure, the pain, the trips to the bathroom. Then ask whether the imaging showed adenomyosis or anything else alongside the fibroids, because a myomectomy only treats what it removes.
Which fibroids do you plan to remove, and would you leave any behind?
Why ask it
Not every fibroid is always taken: very small ones, or ones in an awkward place, may be left. Have the surgeon point to each one on the scan and say what the ones that stay could do later.
I am not planning a pregnancy. Is a myomectomy still a better choice for me than a hysterectomy?
Why ask it
Wanting to keep your uterus is a reason in its own right, and you do not have to back it with a pregnancy plan. The trade to weigh is that new fibroids can grow after a myomectomy, so ask how the two operations compare for you in blood loss, recovery and the chance of needing surgery again.
If I wait, are the fibroids likely to grow, and would a later operation be a bigger one?
Why ask it
Nobody can promise how fast a fibroid will grow, but the surgeon can say what your scans so far suggest. The practical point is whether waiting could close off the smaller approach, and which change in symptoms should bring you back sooner.
How close am I to menopause, and could I manage the symptoms until then instead?
Why ask it
Fibroids are widely described as tending to shrink after menopause, so in your late forties it is fair to ask whether medication could carry you there and what those years would be like. Leave this one out if menopause is a long way off or pregnancy is the reason for the surgery.
Do I need an MRI or any other test before the plan is final?
Why ask it
Ultrasound is where most people start, and some surgeons add an MRI to count the fibroids and map how deep each one sits. Find out what the extra picture would change: the approach, the number removed, or nothing.
Is there any sign that one of these growths is something other than an ordinary fibroid?
Why ask it
Doctors describe a cancer hiding in what looks like a fibroid as rare, and say a scan cannot always exclude it. The useful answer says what in your imaging or history reassures the surgeon, and whether any doubt would change how the tissue is taken out.
Can you recommend someone for a second opinion who uses a different approach from yours?
Why ask it
Surgeons tend to recommend the route they do most, so a second view from someone who works another way is the most informative kind. Take the scan report and the images along, and ask your insurer or health service beforehand whether the extra visit is paid for.
What will I pay in total, and does anything need approval before the date is booked?
Why ask it
A keyhole or robotic myomectomy may be priced differently from an open one, so ask for an estimate of the approach you were offered, listing everyone who will bill you: surgeon, hospital, anesthesia, pathology lab. If an insurer is paying, find out whether the operation must be authorized first and how long that takes; in a public system, ask where you would sit on the waiting list.
The approach
Which approach are you proposing: hysteroscopic, laparoscopic, robotic or open, and why that one for my fibroids?
Why ask it
The reasons usually come down to how many fibroids there are, how big they are and where in the wall they sit. Write the name of the approach down exactly as the surgeon says it, since the scars, the recovery and the advice about a later pregnancy all hang on it.
What rules out the less invasive approaches in my case?
Why ask it
A hysteroscopic myomectomy, done through the cervix with no cuts, generally only reaches fibroids that bulge into the cavity, and keyhole surgery has limits on size and number that vary by surgeon. When the limit turns out to be what this surgeon is trained to do, ask for the name of a colleague who offers the other route.
How often do you do a myomectomy this way, and when did you last do one on fibroids like mine?
Why ask it
A surgeon can do open myomectomies every week and robotic ones a few times a year, or the reverse, so a total for all routes tells you little. The second half matters when yours are unusually large, numerous or deep: you are hoping to hear about a recent case that resembled your own.
Where will the incisions be, and how long?
Why ask it
For an open operation, the detail to get is whether the cut runs low across the bikini line or up and down, and what decides it. With keyhole or robotic surgery, ask how many ports there are and whether one is enlarged to bring the fibroids out. An old cesarean scar is worth pointing out, because some surgeons go back through it and some do not.
How will you get the fibroids out through small incisions?
Why ask it
Large fibroids are often cut into pieces to pass through a small opening, which is called morcellation. Rules and habits around it differ between hospitals and countries, so ask what is done here, whether the cutting happens inside a containment bag, and whether widening one of the incisions is the other choice.
How do you close the wall of the uterus after the fibroids come out?
Why ask it
The stitched muscle is what has to hold in a later pregnancy, so it is fair to ask how the repair is done and in how many layers. If the surgeon closes differently in open and keyhole cases, ask which repair they would choose for someone planning a baby.
Do you expect to cut through into the cavity of the uterus?
Why ask it
Whether the cavity was opened is one of the first things an obstetrician tends to ask about years later. The surgeon may not know until the day, so ask to be told afterwards and to have it written in the operative report.
What will you do if you find more fibroids than the scan showed, or one in a harder place?
Why ask it
Scans do not always show every fibroid, and the count can change once the surgeon sees the uterus itself. Settle in advance whether they would take everything they find, stop at the ones behind your symptoms, or switch approach, so that a choice made while you are asleep is one you have already talked through.
If this is done through the cervix, could it take more than one session to remove the fibroid?
Why ask it
With a hysteroscopic procedure a large or deeply set fibroid is sometimes removed in stages. Get an idea of how likely a second session is for yours and how long the gap between them would be. Not a question for an abdominal operation.
What kind of anesthesia does this approach need, and do I have a choice?
Why ask it
Keyhole and robotic operations are generally done with you fully asleep; an open or hysteroscopic one is sometimes offered with a spinal or sedation instead, depending on the hospital. Where there is a choice, ask how each one feels in the hours afterwards, and report any past trouble with anesthesia well before the morning of surgery.
How long does the operation usually take for fibroids like mine, and is it a day case or an overnight stay?
Why ask it
Hysteroscopic and keyhole cases are often day surgery and open ones usually mean a night or more, but hospitals differ. The hours in the operating room grow with the number of fibroids, so ask for a range and give the top of it to whoever is waiting for you.
Blood loss and risks
How much blood do you expect me to lose, and what do you do during surgery to keep it down?
Why ask it
Bleeding is the risk surgeons talk about most with this operation, because fibroids have a generous blood supply. Several methods are in use, such as a temporary tourniquet or medicine injected into the uterus, so ask which ones this surgeon relies on and why.
What is my blood count now, and what would you want it to be on the day?
Why ask it
Get the hemoglobin as a number, and the ferritin if it was measured. When heavy periods have left you anemic, the follow-up is whether iron tablets or an infusion, and enough weeks for them to work, should come before the date.
Would you want me on medication first to shrink the fibroids or stop my periods?
Why ask it
Some surgeons use a few months of hormone-suppressing treatment before operating, partly so the blood count can recover while the periods are paused, and others prefer not to. Three things to learn: what it would gain you, what the side effects feel like, and how far it pushes the date back.
How likely am I to need a blood transfusion, and what can be arranged in advance?
Why ask it
Two arrangements to ask about: whether blood will be matched and held for you, and whether the hospital can collect and return your own blood during the operation. Anyone who would decline donated blood, on religious or other grounds, should raise it at this visit so the plan is built around that.
What is the chance you would have to do a hysterectomy instead, and what would lead to that?
Why ask it
Surgeons generally call this rare, a last resort for bleeding that cannot be stopped any other way. You are asking for this surgeon's own experience: how often it has happened to their patients, and everything they would try first.
What does the consent form say about hysterectomy, and can my wishes be written on it?
Why ask it
Read the wording days ahead, not on the morning. If keeping your uterus matters to you above almost everything, say exactly that, ask what 'only to save my life' would mean in practice, and have the conversation noted in your chart.
How often do you start with keyhole surgery and end up making an open incision?
Why ask it
Bleeding that is hard to control through the ports, a fibroid deeper than the scan suggested and scar tissue from earlier surgery are the reasons usually given. Ask which of them applies to you and how often it has happened in this surgeon's own keyhole cases, then give your employer the longer recovery time, not the shorter one.
Besides bleeding, which complications do you watch for with this operation, and which matter most for me?
Why ask it
Expect to hear about infection, a clot in the leg or lung, and injury to the bladder or bowel; with a hysteroscopic procedure the list is different, and includes absorbing too much of the fluid used to hold the cavity open. Mention earlier operations, cesareans, any clot in you or a close relative and anything you take that thins the blood, since each can move the answer.
What is the risk of scar tissue forming around my uterus afterwards, and do you use anything to prevent it?
Why ask it
Adhesions, bands of scar between the uterus and nearby organs, are a known issue after this surgery and can matter for fertility and for pain. Some surgeons lay a barrier over the stitched area and some do not, so ask for the reasoning either way.
Could scarring form inside the cavity itself, and how would you check for it?
Why ask it
This matters most when fibroids are removed from the cavity. Ask whether a follow-up look with a camera or a scan is routine for this surgeon, and which signs, such as periods that become much lighter than before, should make you request one.
Which of my medications and supplements should I stop before the operation, and on what day?
Why ask it
Whatever affects bleeding comes first: blood thinners, aspirin, anti-inflammatory painkillers, and supplements such as fish oil that some surgeons ask patients to pause. Go through the rest of the list as well, birth control and diabetes or weight-loss injections included, and write beside each one the day it stops and the day it starts again.
Fertility and pregnancy
How is this operation likely to affect my chances of getting pregnant?
Why ask it
Much depends on where the fibroids are, and the ones that distort the cavity are the ones most often linked with trouble conceiving. Press for a view on yours: does the surgeon expect removal to help, to make no difference, or to carry a risk of its own through scarring?
How long should I wait after surgery before trying to conceive?
Why ask it
Advice ranges from a matter of weeks after a hysteroscopic procedure to several months after an abdominal one, and surgeons differ. Leave with a date, the contraception that fits the gap, and whether a scan is wanted before you start.
After this, would I be advised to have a cesarean, or could I plan a vaginal birth?
Why ask it
It tends to turn on how deep the cuts into the uterine wall go and whether the cavity is opened, so a firm answer may only be possible after the operation. Hear what the surgeon expects now, then ask again at follow-up and write it down for whoever looks after the pregnancy.
What is the risk of the scar on my uterus giving way in pregnancy or labor, and what lowers it?
Why ask it
The scar opening, which doctors call uterine rupture, is the reason delivery plans change after a myomectomy, though it is reported as uncommon. Ask how the repair, the healing time and the timing of delivery each bear on it, and which symptoms in a pregnancy should send you straight in.
Should I see a fertility specialist before the operation, not after?
Why ask it
Worth raising if you have been trying for a while, are past your mid-thirties or expect to need IVF. A specialist may want tests done first, may have a view on which fibroids need to come out, and can time treatment around the healing period.
If I want a baby in a few years and not now, is it better to operate now or closer to the time?
Why ask it
New fibroids can grow in the years between surgery and trying, which is the argument for waiting; worsening symptoms and bigger fibroids are the argument against. Have the surgeon say which way they lean for you and what they would watch in the meantime.
What should I do if I become pregnant sooner than you advised?
Why ask it
It happens, and the answer should be a plan, not a scolding. Find out who to call and whether early care would differ, and make sure the pregnancy team is given the details of the surgery.
Can I have a copy of the operative report, and what in it will an obstetrician need?
Why ask it
You may be pregnant years from now, in another city, under a doctor who has never met this surgeon. The report records how many fibroids came out, from where, how deep the cuts went and how they were closed, so collect it at the follow-up visit and keep it with your own papers.
Recovery and recurrence
How long is recovery for the approach you plan, and how much longer if it turns into an open operation?
Why ask it
Get both figures in weeks, then ask what marks each stage for most of their patients: the first walk outside, the first day without a nap, the first full day at a desk. After a hysteroscopic procedure people often count recovery in days, so on that route ask what the surgeon means by recovered.
What pain should I expect in the first days, and what will I go home with?
Why ask it
The answer changes with the route: cramping and some bleeding after a hysteroscopic procedure, bloating and a sore shoulder from the gas after keyhole surgery, the incision itself after an open one. Ask for the first week's plan on paper, with what to take first, what to add if that is not enough, and the number to ring at a weekend.
When can I lift, drive, exercise and have sex again?
Why ask it
Take them separately, because the dates differ and so do the reasons: the abdominal wall for lifting, the pain tablets and the brake pedal for driving, the stitched uterus for sex. Check whether tampons, baths and swimming follow the same rule, and what weight counts as lifting if you carry a small child.
How much time should I arrange off work for my kind of job?
Why ask it
Say what a working day involves, the hours on your feet, the loads you carry, the length of the drive, and ask for one date for light duties and another for the full job. The surgeon can give the medical timings and sign the forms, but sick pay and leave rights depend on your employer and where you live, so ask your workplace how it works there.
What will my periods be like afterwards, and when should I see the improvement?
Why ask it
The first one or two can be heavier or oddly timed, and surgeons vary in how long they wait before judging the result. Agree on a point, the third period for instance, at which heavy bleeding that is still there means a call to the office.
Which symptoms afterwards mean call the office, and which mean go to emergency care?
Why ask it
Fever, bleeding that soaks pads quickly, a swollen or painful calf, breathlessness and a wound that opens or leaks are the ones to raise by name. For each, get a plain instruction, phone or go in, and save the number that is answered at night before you leave the building.
How likely are new fibroids to grow, and what would you suggest if they did?
Why ask it
A myomectomy removes the fibroids that are there, not the tendency to form them, and surgeons generally say the odds of more go up the younger you are and the more you started with. Ask what the options would be a second time, and whether repeat surgery is harder.
What follow-up will I have, and when is the first scan?
Why ask it
Three details: when the post-operative visit is, whether an ultrasound is planned to give a new baseline, and who sees you after that, this surgeon or your regular gynecologist. If another clinic referred you, check that the operative report will be sent back to it.
When will I hear what the lab found in the tissue?
Why ask it
Fibroids that are taken out normally go to a pathologist, who confirms under the microscope that they are what they appeared to be. Find out how long that takes there and how the result reaches you, and do not read silence as an all-clear: ring if the date passes.
Making the most of a myomectomy consultation
Practical guidance for the conversation itself
Before you sit down with the surgeon
Bring the scan report itself
Ask for the written ultrasound or MRI report and, if you can, the images on a disc or a portal login. A surgeon giving a second opinion needs the number, size and position of each fibroid, and 'several, quite large' from memory gives them nothing to work with.
Know where you stand on pregnancy
Yes, no and not sure are all usable answers, but the surgeon has to hear one of them. It affects which fibroids are removed, how the uterus is repaired and which alternatives are on the table at all, so say it in the first minute.
Keep a month of symptoms on paper
Note the days of bleeding, how often you change a pad or tampon on the worst day, the nights you get up to pass urine and the days of work you miss. That record is also what you will hold the result against a few months after the operation.
Which group to open first
Someone still weighing the operation gets the most from the decision and approach groups. With a date booked, turn to blood loss and recovery, the two groups with deadlines in them, because iron, matched blood and time off all take weeks to arrange. If a pregnancy is hoped for, the fertility group belongs in the visit at either stage.
The vocabulary of fibroid surgery
Where a fibroid sits
Submucosal fibroids bulge into the cavity of the uterus, intramural ones lie within the muscle wall, and subserosal ones grow on the outside. A pedunculated fibroid hangs from a stalk. Most of what a surgeon recommends follows from these words, so find yours in the report.
The four routes
A hysteroscopic myomectomy goes in through the vagina and cervix with a camera, leaves no cuts on the abdomen, and is for fibroids inside the cavity. Laparoscopic surgery, often called keyhole, uses several small cuts and a camera; in a robotic myomectomy the route is the same and the surgeon guides the instruments from a console beside the table. An open myomectomy, written as abdominal myomectomy or laparotomy in the notes, is done through one longer incision.
Morcellation
Cutting a fibroid into strips or pieces so that it fits through a small opening. Because it could spread cells from a growth that turned out not to be benign, many hospitals have rules about when and how it is done, often inside a bag. Ask what the policy is where you are being treated.
Conversion
The word is used two ways, so check which is meant: converting from keyhole to open surgery, or converting from myomectomy to hysterectomy. They are very different events, and a consent form may mention both in a single line.
Where the consent conversation goes wrong
Meeting the hysterectomy line on the morning
The possibility of hysterectomy is commonly written into myomectomy consent, and it is a shock to read it for the first time in a gown with a pen in your hand. Ask for the form at the consultation and take a copy home.
Leaving your limits unsaid
Tell the surgeon in plain words what you would accept and in what circumstances, and ask for that conversation to be recorded in your notes. What a form can and cannot restrict depends on local law and hospital policy, so ask how it works there.
Assuming the person with the form is the person who operates
In some hospitals a junior doctor or a nurse goes through the consent form with you. If your questions about hysterectomy or blood were answered by someone else, ask for a few minutes with the operating surgeon before the day.
Raising blood too late
A rare blood type, antibodies from an earlier transfusion or pregnancy, or an objection to blood products all need saying weeks ahead. Holding matched blood or setting up collection of your own during surgery takes planning that cannot be done at the door of the operating room.
Papers to keep once it is done
The operative report
Request it at the follow-up visit, while you are in the office and the file is open. It should say how many fibroids were removed, where each one was, whether the cavity was entered and how the wall was closed.
The delivery advice, in the surgeon's words
Ask the surgeon to write one line on what they recommend for a future birth and why. An obstetrician years later can work from that sentence far more easily than from your recollection of it.
The earliest date to try
If pregnancy is the plan, put the date you were cleared to start trying into your calendar, with the contraception you are using until then. When a scan or check is wanted first, note who is meant to order it.
A new baseline scan
If an ultrasound is done some months after surgery, keep that report as well. Every later scan gets compared with it, and it turns 'have they come back?' into a question with an answer.