LAST year we performed a myomectomy on a patient of mine. She was a 38-year-old woman who suffered from painful, prolonged, and heavy cycles. Her constant anaemia made simple tasks such as walking up the stairs difficult. She feared her monthly menses due to the extreme pain which she would have to endure. On the days that she found the strength to go to work whilst seeing her menses, she would constantly be embarrassed by the excessive bleeding that would often cause in-office accidents. After stabilising her anaemia via hormonal and dietary techniques, we discussed a potential myomectomy. Though the thought of surgery was frightening, she decided on proceeding. One year later, she is living a normal life with no more heavy or painful cycles and is very grateful for the decision she made.

Stories like hers are common. Myomectomy is one of the most effective treatments for uterine fibroids, restoring health, fertility, and quality of life for thousands of women each year. The majority of women recover well. However, it is important to acknowledge that like any surgery, there are risks. Knowing them allows patients to make informed decisions and approach recovery with realistic expectations.

Here are some of the complications that can occur whilst performing a myomectomy and methods to decrease same.

Blood loss and transfusion

Fibroids are often highly vascular and fed by numerous blood vessels. The aim of a myomectomy is to remove all fibroids — leave no soldier behind! Removing them can sometimes lead to significant blood loss, and in some cases, a transfusion may be needed. This is one of the most common risks, particularly when multiple or very large fibroids are involved. Intraoperative medication and techniques can be done to significantly reduce blood loss during surgery.

Adhesions, scar tissue, and bowel obstruction

After surgery, scar tissue may form in the pelvis. These adhesions can sometimes bind pelvic organs together, causing pain or affecting fertility. In rare cases, the intestines may become involved, leading to bowel obstruction — a serious complication that can present with bloating, vomiting, and severe abdominal pain. Surgeons use careful techniques to reduce this risk, but it cannot be eliminated entirely.

Infection

Infection can occur at the incision site or within the pelvis. While most cases respond well to antibiotics, they may extend the recovery period. Strict sterile practices with pre-operative and post-operative antibiotics are international standard measures used to minimise this risk.

Injury to nearby organs

The uterus is surrounded by vital structures such as the bladder, bowel, and ureters. Though rare, these organs can be injured during surgery and may require repair. If this occurs, they are usually identified immediately and are rectified.

Delayed symptom improvement

Although all fibroids are removed, patients should be made aware that relief is not always immediate. It may take three to six months for heavy bleeding, pelvic pressure, or bloating to normalise as the uterus heals and restructures.

Recurrence of fibroids

Myomectomy removes existing fibroids but does not prevent new ones from developing. A small cohort of women may be at risk for recurrence. This recurrence may be as small seedling fibroids to much larger fibroids from as little as a few months to years post-surgery. With removal of all fibroids, the recurrence rate should be less but may not be absent. Close follow-up is recommended with yearly check-ups and ultrasounds. Most recently the addition of green tea extract and vitamin D have been shown to decrease the incidence of recurrence.

Deep vein thrombosis and pulmonary embolism

Like all major surgeries, there is a small risk of developing blood clots in the legs (deep vein thrombosis). If a clot travels to the lungs, it becomes a pulmonary embolism, which is potentially life-threatening. Preventive strategies — such as compression stockings, early mobilisation after surgery, and blood-thinning medication when needed — greatly reduce this risk.

Uterine rupture in future pregnancies

Myomectomies usually involve multiple incisions throughout the entire uterus. These incisions are potential “weakened areas”. If labour occurs whilst pregnant, the force generated can cause these weakened areas to rupture, which is a potential life-threatening scenario for both mother and baby. This is usually avoided by performing a planned C-Section at full term.

Hysterectomy as a last resort

Though uncommon, in situations where bleeding cannot be controlled or complications arise, hysterectomy (removal of the uterus) may become necessary — even when the original plan was to preserve the uterus.

Anaesthetic complications

Surgery not only involves the actual surgery but also the role of anaesthesia. Most myomectomies involve general anaesthesia (patients are put to sleep). The anaesthesiologist plays a key role in ensuring the patient is relaxed , has good pain control (whilst asleep), and carefully monitors the patient’s vital signs whilst the surgeons operate. Anaesthesia has its own particular risks of complications such as difficult intubation (placing the tube into the windpipe so that the machine can breathe for the patient), lung collapse, and a few others. The anaesthesiologist will usually discuss these risks separately with the patient.

How risks are minimised generally

The main way to minimise risk is to anticipate them.

What do I mean by this ? Presurigcal planning is crucial for good outcomes and low complications and this goes for all surgeries — major and minor — not just a myomectomy.

Certain patients would be more at risk for certain complications than others. For example, a patient who had previous surgery for an appendectomy (removal of appendix) and presents with fibroids for a myomectomy would be more at risk for potential damage to other organs, such as the bowel (due to anticipated scar tissue from the previous appendectomy). It would be advised for this case that a senior obstetrician-gynaecologist performs same with the potential assistance of a general surgeon. Or if a woman has large fibroids and potential blood loss is anticipated, it would be advised that blood be reserved and present in the operating theatre for this patient if needed.

The bottom line

Myomectomy remains a safe and highly effective procedure for treating symptomatic fibroids. Most women experience significant improvement in their health and quality of life, just like my patient. Still, it is important to recognise the potential risks.

The key message is this: Complications are uncommon, and most can be prevented or managed with the right expertise and preparation. Women considering surgery should speak openly with their gynaecologist, weigh the benefits and risks, and feel reassured that, with proper care, the outcome is overwhelmingly positive

Dr Daryl Daley is a cosmetic gynaecologist and obstetrician. He is located at 3D Gynaecology Limited, 23 Tangerine Place, Kingston 10. Feel free to contact Dr Daley at ddaley@3dgynae.com.

Dr Daryl Daley.