Myomectomy: Preserving Fertility, Relieving Symptoms – A Comprehensive Guide for Indian Women

Uterine fibroids are a common concern for women, affecting millions globally. These non-cancerous growths in the uterus can cause a range of uncomfortable symptoms, impacting daily life and, for many, their dreams of motherhood. In India, where family planning and fertility are deeply valued, finding effective solutions that preserve the uterus is paramount. This is where Myomectomy shines as a beacon of hope.

Myomectomy is a specialized surgical procedure designed to remove uterine fibroids while meticulously preserving the uterus. Unlike a hysterectomy, which involves the removal of the entire uterus, myomectomy offers women the chance to retain their fertility and avoid major anatomical changes. With India's rapidly advancing medical infrastructure and a pool of highly skilled specialists, myomectomy has become a preferred and accessible treatment option for women across the country.

This comprehensive guide delves into everything you need to know about myomectomy – its purpose, the various procedures available, what to expect during preparation and recovery, the potential outcomes, and a detailed breakdown of costs in India.

What is Myomectomy?

At its core, myomectomy is a surgical intervention aimed at selectively removing benign (non-cancerous) growths known as uterine fibroids from the muscular wall of the uterus, while leaving the uterus intact. These fibroids, also called leiomyomas or myomas, are solid, compact tumours made of smooth muscle cells and fibrous connective tissue that develop within the uterine wall. They can vary dramatically in size, from tiny seedlings detectable only under a microscope to bulky masses that can distort and enlarge the uterus.

Uterine fibroids are incredibly common, affecting up to 70-80% of women by age 50, though not all will experience symptoms. They typically appear during a woman's reproductive years, often shrinking after menopause due to declining hormone levels. While the exact cause remains unknown, their growth is influenced by hormones like estrogen and progesterone, and there's often a genetic predisposition.

Myomectomy stands as a vital alternative to hysterectomy (removal of the entire uterus), particularly for women who:

• Desire to preserve their fertility and have future pregnancies.
• Wish to avoid a hysterectomy for personal, cultural, or medical reasons.
• Are experiencing significant symptoms caused by fibroids that impact their quality of life.

The procedure is a testament to modern gynaecological surgery's ability to offer targeted treatment, focusing on the problem area while maintaining the integrity and function of the reproductive organs. In India, the availability of advanced surgical techniques and highly experienced gynaecologists makes myomectomy a widely sought-after and successful treatment for countless women.

Why is Myomectomy Performed?

The primary objective of a myomectomy is two-fold: to effectively alleviate the debilitating symptoms caused by uterine fibroids and to enhance the chances of conception and successful pregnancy for women desiring future fertility. Fibroids, depending on their size, number, and location, can wreak havoc on a woman's health and well-being.

Here's a detailed look at the common reasons why myomectomy is recommended:

1. Alleviating Troublesome Symptoms

Uterine fibroids are notorious for causing a range of uncomfortable and sometimes severe symptoms that significantly diminish a woman's quality of life. Myomectomy targets the source of these issues, offering profound relief:

• Heavy Menstrual Bleeding (Menorrhagia): This is one of the most common and distressing symptoms. Fibroids, especially submucosal ones that protrude into the uterine cavity, can increase the surface area of the uterine lining, leading to heavier and prolonged periods. They can also interfere with the uterus's ability to contract effectively, which is crucial for stopping bleeding. Chronic heavy bleeding often results in anemia, causing severe fatigue, weakness, dizziness, and pallor, impacting daily activities and productivity. Myomectomy removes these fibroids, restoring normal menstrual flow and improving iron levels.
• Pelvic Pain, Pressure, or Discomfort: Large or numerous fibroids can exert significant pressure on the surrounding pelvic organs. Women may experience a persistent feeling of heaviness or fullness in the lower abdomen, chronic pelvic pain, or even sharp, acute pain if a fibroid degenerates. This discomfort can radiate to the back and legs, making standing, sitting, or exercising difficult. Myomectomy removes the physical bulk, relieving this pressure and pain.
• Frequent Urination or Difficulty Emptying the Bladder: When fibroids grow on the front of the uterus, they can press against the bladder. This pressure reduces the bladder's capacity and can lead to a constant urge to urinate, even when the bladder isn't full. Conversely, some women may experience difficulty fully emptying their bladder, increasing the risk of urinary tract infections.
• Constipation: Fibroids located at the back of the uterus can press against the rectum, making bowel movements difficult and leading to chronic constipation. This can cause significant discomfort and bloating.
• Enlargement of the Abdomen: Very large fibroids can cause the abdomen to swell, sometimes mimicking pregnancy or leading to an uncomfortable protruding belly. This can affect body image and make clothing uncomfortable.
• Pain During Intercourse (Dyspareunia): Depending on their location, some fibroids can cause pain or discomfort during sexual activity.

2. Improving Fertility and Pregnancy Outcomes

For many women, especially in India, the preservation of fertility is a primary concern. Fibroids can interfere with conception and pregnancy in several ways:

• Interference with Implantation: Submucosal fibroids, which grow into the uterine cavity, can distort the uterine lining, making it difficult for an embryo to implant successfully. They can also reduce blood flow to the endometrium, creating an unfavourable environment for implantation.
• Blocking Fallopian Tubes: In rare cases, fibroids located near the fallopian tubes can block them, preventing sperm from reaching the egg or a fertilized egg from travelling to the uterus.
• Distortion of Uterine Shape: Large or multiple fibroids can significantly alter the normal shape of the uterus, which can hinder the proper development of a pregnancy and increase the risk of miscarriage or preterm labour.
• Recurrent Pregnancy Loss: Fibroids are a known factor contributing to recurrent miscarriages. By removing these growths, myomectomy can improve the uterine environment, thereby reducing the risk of pregnancy loss.

For women in India, where the desire for children is often paramount, myomectomy offers a tailored and hopeful solution. It allows them to address their health concerns without sacrificing their reproductive potential, leveraging the expertise of skilled Indian specialists and advanced medical facilities.

Preparation for Myomectomy

Thorough preparation is crucial for ensuring a safe and successful myomectomy, minimizing risks, and facilitating a smooth recovery. For Indian patients, this preparatory phase is meticulously managed by healthcare providers, integrating comprehensive medical assessments with practical advice.

Here's what to expect during the preparation for your myomectomy:

1. Consultation and Comprehensive Evaluation

Your journey begins with an in-depth consultation with your gynaecologist. This is an opportunity to discuss:

• Your complete medical history: Including any pre-existing conditions (e.g., diabetes, hypertension), previous surgeries, and family history.
• Current medications, supplements, and allergies: It's vital to disclose everything you're taking, as some medications might need to be adjusted or stopped.
• Your symptoms and their impact: A detailed description of your fibroid-related symptoms, their severity, and how they affect your daily life.
• Fertility goals: Whether you desire future pregnancies is a critical factor in planning the surgical approach and post-operative care.
• Your expectations and concerns: Open communication with your doctor helps address any anxieties and ensures you are fully informed.

2. Medical Tests and Imaging

A series of diagnostic tests will be conducted to provide a clear picture of your overall health and the specifics of your fibroids:

• Blood Tests:
  • Complete Blood Count (CBC): To check for anemia (low haemoglobin) due to heavy bleeding, which is common with fibroids.
  • Blood Group and Cross-matching: In case a blood transfusion is needed during or after surgery.
  • Coagulation Profile (PT, aPTT): To assess your blood's clotting ability, crucial for preventing excessive bleeding.
  • Kidney and Liver Function Tests: To ensure these vital organs are functioning well, especially relevant for anesthesia.
• Urine Tests: To rule out any urinary tract infections (UTIs) before surgery.
• Electrocardiogram (ECG) and Chest X-ray: To assess your heart and lung health, ensuring you are fit for general anesthesia.
• Imaging Tests: These are essential for mapping the fibroids accurately:
  • Pelvic Ultrasound: Usually the first imaging test, providing initial information about fibroid size, number, and location.
  • Magnetic Resonance Imaging (MRI): Often considered the gold standard, an MRI provides highly detailed images, precisely locating fibroids, determining their size, distinguishing them from other growths, and assessing their depth within the uterine wall. This helps the surgeon plan the most effective and least invasive approach.
  • Hysterosalpingography (HSG) or Saline Infusion Sonography (SIS): If infertility is a concern, these tests might be performed to evaluate the uterine cavity and fallopian tubes for any blockages or distortions.

3. Medication Adjustments

Your doctor will provide specific instructions regarding your medications:

• Blood Thinners: Medications like aspirin, ibuprofen, warfarin, or clopidogrel must typically be stopped a week or more before surgery to minimize the risk of excessive bleeding. Your doctor will guide you on the exact duration based on your specific medication and health condition.
• Other Medications: Discuss all prescription and over-the-counter drugs, herbal supplements, and vitamins. Some may need to be temporarily discontinued.

4. GnRHa Injections (Pre-operative Shrinkage)

For women with very large fibroids or significant anemia, your doctor might recommend a course of Gonadotropin-Releasing Hormone agonist (GnRHa) injections for two to three months before surgery.

• How they work: GnRHa injections induce a temporary, reversible menopause-like state by reducing estrogen levels, which in turn causes the fibroids to shrink.
• Benefits: Shrinking fibroids can make their removal easier, reduce the size of the uterus, decrease intraoperative blood loss, and allow time to build up iron stores if you are anemic.

5. Fasting and Bowel Preparation

• Fasting: You will be instructed to fast for a certain period (typically 6-8 hours for food and 2-4 hours for clear liquids) before surgery. This is crucial to prevent complications related to anesthesia, such as aspiration (inhaling stomach contents into the lungs).
• Bowel Preparation: In some cases, particularly for larger fibroids or open abdominal surgery, your doctor might advise an enema or a mild laxative the night before surgery to clear the bowels. This helps provide a clearer surgical field and reduces the risk of bowel injury.

6. Logistics and Lifestyle Adjustments

• Arranging Support: Plan for a family member or friend to accompany you to the hospital, assist you post-discharge, and help during your initial recovery period. General anesthesia will make it unsafe to drive.
• Compression Stockings: You may be advised to wear compression stockings before and after surgery to help prevent deep vein thrombosis (DVT) or blood clots, especially important for longer procedures or if you have risk factors.
• Smoking and Alcohol: If you smoke, you will be strongly advised to stop several weeks before surgery, as smoking can impair healing and increase surgical risks. Alcohol consumption should also be curtailed.
• Nutritional Support: If you are anemic, your doctor might prescribe iron supplements and advise a diet rich in iron to improve your haemoglobin levels before surgery.

By diligently following these preparatory steps, you significantly contribute to the safety and success of your myomectomy, setting the stage for a smoother procedure and a faster recovery.

The Myomectomy Procedure

Myomectomy can be performed using various surgical approaches, each tailored to the specific characteristics of the fibroids (size, number, location) and the patient's individual health and reproductive goals. The choice of procedure is a crucial decision made in consultation with your surgeon. All procedures are typically performed under general anesthesia.

Here are the main types of myomectomy procedures:

1. Abdominal Myomectomy (Open Myomectomy)

This is the traditional approach, often recommended for larger, numerous, or deeply embedded fibroids that are difficult to access with minimally invasive techniques.

• Incision: The surgeon makes an incision in the lower abdomen. This can be:
  • Horizontal (Bikini Cut): A curvilinear incision made just above the pubic hairline. This is cosmetically preferred as the scar is easily concealed.
  • Vertical Incision: Made from the navel down to the pubic bone. This is generally reserved for very large fibroids, when extensive access is needed, or in emergency situations.
• Procedure:
  1. After the incision, the abdominal muscles are carefully separated to expose the uterus.
  2. The surgeon makes an incision into the uterine wall, directly over each fibroid.
  3. Each fibroid is carefully "enucleated" or removed from its bed within the uterine muscle.
  4. Once all fibroids are removed, the uterine muscle layers are meticulously repaired with sutures. This multi-layer closure is critical to restore the uterus's structural integrity, minimize scarring, and ensure its strength for future pregnancies.
  5. The abdominal incision is then closed in layers.
• Advantages: Allows for the removal of very large, numerous, or deeply embedded fibroids that might be challenging with other methods. Provides excellent tactile feedback for the surgeon.
• Disadvantages: Involves a larger incision, potentially leading to more post-operative pain, a longer hospital stay (2-4 days), and a longer recovery period (4-6 weeks). There is also a higher risk of adhesion formation compared to minimally invasive approaches.

2. Laparoscopic Myomectomy (Minimally Invasive)

This technique uses small incisions and specialized instruments, offering several advantages over open surgery. It is typically suitable for smaller, fewer, and externally located fibroids.

• Incisions: Usually involves 3-4 small incisions, each about 0.5-1 cm in length, in the abdomen. One incision is typically at the navel, and others are in the lower abdomen.
• Procedure:
  1. The abdomen is gently inflated with carbon dioxide gas (insufflation) to create space and better visibility.
  2. A laparoscope (a thin tube with a camera) is inserted through one incision, providing a magnified view of the pelvic organs on a monitor.
  3. Specialized surgical instruments are inserted through the other small incisions.
  4. The surgeon carefully dissects and removes the fibroids.
  5. To remove the fibroids from the abdomen, they are often cut into smaller pieces (morcellated) within a protective bag or removed through one of the incisions. In some cases, if the fibroids are small, they might be removed through the vagina.
  6. The uterine muscle is then meticulously repaired using sutures, often with barbed sutures that make the process more efficient.
  7. The small incisions are closed with sutures or surgical tape.
• Advantages: Less post-operative pain, shorter hospital stay (1-2 days), quicker recovery (2-4 weeks), smaller and more cosmetically appealing scars, and generally lower risk of adhesion formation.
• Disadvantages: May not be suitable for very large or numerous fibroids. Requires specialized surgical skills and equipment. The morcellation process (if done outside a bag) carries a very small risk of spreading undetected cancerous cells (though fibroids are almost always benign).

3. Hysteroscopic Myomectomy

This technique is specifically designed for submucosal fibroids, which are located just beneath the uterine lining and protrude into the uterine cavity. It does not involve any external abdominal incisions.

• Approach: The procedure is performed transvaginally, meaning instruments are inserted through the vagina and cervix into the uterus.
• Procedure:
  1. A hysteroscope (a thin, lighted telescope with a camera) is inserted through the cervix into the uterine cavity.
  2. A saline solution is continuously infused into the uterus to gently expand the cavity, allowing for clear visualization of the fibroids and the uterine lining.
  3. Specialized instruments, such as a resectoscope (which uses an electrical current to cut and coagulate tissue) or hysteroscopic morcellator, are passed through the hysteroscope.
  4. The surgeon carefully shaves or cuts away the fibroid tissue from the uterine wall. The resected fibroid pieces are then flushed out with the saline solution.
• Advantages: No external incisions, minimal pain, often an outpatient (same-day) procedure, and a very quick recovery (a few days to a week).
• Disadvantages: Only suitable for submucosal fibroids. The size and depth of the fibroid are also factors. There's a small risk of fluid overload or uterine perforation.

4. Robotic-Assisted Myomectomy

This is a technologically advanced form of laparoscopic myomectomy that offers enhanced precision and control.

• Procedure: Similar to laparoscopic myomectomy, small abdominal incisions are made. However, instead of the surgeon directly manipulating instruments, robotic arms are inserted through the incisions. The surgeon sits at a console, viewing a high-definition 3D image of the surgical field, and controls the robotic arms with hand and foot controls. The robotic instruments have a greater range of motion and dexterity than human hands.
• Advantages: Enhanced precision, improved dexterity, superior 3D visualization, and greater ergonomic comfort for the surgeon, which can be particularly beneficial for complex, multiple, or hard-to-reach fibroids. It often allows for very meticulous uterine repair.
• Disadvantages: Higher cost due to specialized equipment and training. Still requires small incisions, similar recovery profile to traditional laparoscopic myomectomy, but potentially with even less blood loss and improved outcomes for complex cases.

The choice of myomectomy technique is a critical decision that your surgeon will make based on a thorough evaluation of your fibroids, your overall health, and your desire for future pregnancy. Each method aims to achieve the same goal: effective fibroid removal while preserving the uterus.

Understanding Results

Myomectomy generally yields very positive outcomes for women suffering from uterine fibroids, particularly in India, where access to advanced facilities and skilled surgeons ensures high standards of care. The results can be transformative, significantly improving quality of life and reproductive prospects.

1. Symptom Relief

The most immediate and gratifying result for most women is the significant alleviation of their fibroid-related symptoms:

• Heavy Menstrual Bleeding: Most women experience a dramatic reduction in menstrual blood loss, often within the first few cycles after surgery. This leads to improved haemoglobin levels, increased energy, and a reduction in anemia-related fatigue.
• Pelvic Pain and Pressure: The removal of fibroids eliminates the source of pressure on surrounding organs, leading to substantial relief from pelvic pain, discomfort, and the feeling of fullness or heaviness in the abdomen.
• Urinary and Bowel Symptoms: Pressure on the bladder and rectum is relieved, resulting in a return to normal urinary frequency and improved bowel function.
• Abdominal Enlargement: For women with large fibroids, the reduction in abdominal size can be a significant aesthetic and comfort improvement.

Overall, studies consistently show that over 90% of women experience substantial symptom relief after myomectomy, leading to a significant improvement in their daily lives and well-being.

2. Fertility Improvement

For women who wish to conceive, myomectomy can be a game-changer:

• Enhanced Conception Rates: By removing fibroids that distort the uterine cavity, block fallopian tubes, or interfere with implantation, myomectomy significantly improves the uterine environment for conception. Research indicates that conception rates can improve substantially after surgery, with some studies showing rates as high as 68.5% post-myomectomy compared to 25.7% pre-myomectomy in carefully selected patients.
• Reduced Miscarriage Risk: For women with a history of recurrent pregnancy loss attributed to fibroids, myomectomy can reduce the risk of future miscarriages.
• Waiting Period: It is generally advised to wait for a period of 3 to 6 months after myomectomy before attempting pregnancy. This crucial waiting period allows the uterus to fully heal, the surgical scars to gain optimal strength, and the uterine wall to recover its integrity, minimizing the risk of complications during pregnancy.

3. Pregnancy Outcomes

Many women successfully carry pregnancies to term after myomectomy:

• Successful Pregnancies: The majority of women who conceive after myomectomy have healthy, successful pregnancies.
• Close Monitoring: Due to the uterine scar, pregnancies after myomectomy are often considered high-risk and require close monitoring by an obstetrician. This is to watch for any potential complications, though rare, such as uterine rupture, especially during labour.
• Caesarean Section (C-section) Delivery: In many cases, a C-section delivery is recommended or even mandatory for women who have undergone myomectomy, particularly if the fibroids were large or deeply embedded (intramural) and required extensive uterine incisions. This decision is made to avoid the stress and strong contractions of labour on the healing uterine scar, thereby preventing the extremely rare but serious complication of uterine rupture. Your obstetrician will discuss the safest mode of delivery based on the specifics of your surgery and pregnancy.

4. Recovery

Recovery time varies significantly depending on the type of myomectomy performed:

• Abdominal Myomectomy (Open):
  • Hospital Stay: Typically 2 to 4 days.
  • Full Recovery: Up to 6 weeks. During this time, you will need to limit physical activity, avoid heavy lifting, and allow your body to heal. Pain management is crucial in the initial days.
• Laparoscopic or Robotic-Assisted Myomectomy:
  • Hospital Stay: Usually 1 to 2 days.
  • Full Recovery: Generally 2 to 4 weeks. Patients experience less pain, can often return to light activities sooner, and have smaller scars.
• Hysteroscopic Myomectomy:
  • Hospital Stay: Often an outpatient procedure, meaning you can go home the same day.
  • Full Recovery: A few days to a week. This is the least invasive option with the quickest recovery, as there are no external incisions.

Regardless of the procedure, it’s essential to follow your surgeon's post-operative instructions diligently, including wound care, medication schedules, and activity restrictions, to ensure optimal healing and prevent complications.

Potential Risks and Complications

While myomectomy is generally safe and effective, like any surgical procedure, it carries potential risks. It's important to be aware of these:

• Bleeding: Some bleeding is expected during surgery. However, excessive bleeding (haemorrhage) can occur, occasionally requiring a blood transfusion. Patients with pre-existing anemia are at higher risk.
• Infection: There is a risk of infection at the incision site (for abdominal/laparoscopic surgery) or within the uterus. This is typically managed with antibiotics.
• Pain: Postoperative pain is common and is usually managed effectively with prescribed pain medication.
• Scarring and Adhesions: Internal scarring (adhesions) can form within the abdomen or uterus after surgery. These bands of scar tissue can sometimes cause chronic pelvic pain or, rarely, contribute to infertility. Minimally invasive techniques (laparoscopic/robotic) are associated with a lower risk of adhesion formation compared to open surgery.
• Uterine Perforation: In rare instances, the uterine wall may be accidentally punctured or perforated during the procedure, particularly during hysteroscopic myomectomy.
• Anesthesia Complications: Although rare, complications related to general anesthesia can occur, such as allergic reactions, respiratory problems, or cardiovascular events.
• Infertility: While myomectomy aims to improve fertility, there is a very small risk that surgical complications (e.g., severe adhesion formation) could paradoxically affect future fertility. This is not a common outcome.
• Recurrence of Fibroids: This is an important consideration. Myomectomy removes existing fibroids, but it does not prevent new ones from growing. The risk of new fibroids developing after surgery is higher for women who had multiple fibroids or are younger at the time of surgery. The rate of recurrence varies but can be significant over several years. Regular follow-up and monitoring are important.
• Hysterectomy: In extremely rare and unforeseen circumstances, such as uncontrollable bleeding during the procedure or the discovery of other severe abnormalities, the surgeon may need to perform an emergency hysterectomy (removal of the uterus) to safeguard the patient's life. This is a very rare last resort.

Your surgeon will discuss these risks with you in detail during the consultation, ensuring you make an informed decision about your treatment.

Costs in India

One of the significant advantages for patients considering myomectomy is the comparatively affordable cost of high-quality medical care in India. This makes it a financially viable and attractive option for many women, both within India and from abroad. However, the exact cost of a myomectomy can vary substantially based on several critical factors.

Here's a detailed breakdown of the factors influencing myomectomy costs in India and estimated ranges:

Factors Influencing Myomectomy Costs

1. Type of Surgical Approach:

   • Abdominal (Open) Myomectomy: Generally the least expensive due to less specialized equipment required.
   • Laparoscopic Myomectomy: Moderately more expensive than open surgery, as it involves advanced endoscopic instruments and specialized training.
   • Hysteroscopic Myomectomy: Costs can vary, often being lower for simpler, outpatient procedures, but can increase with the complexity of the fibroids.
   • Robotic-Assisted Myomectomy: Typically the most expensive option due to the high cost of robotic equipment, maintenance, and specialized surgeon training.

2. Surgeon's Fees: The experience, reputation, and skill level of the gynaecological surgeon play a significant role. Highly experienced and renowned surgeons in metro cities will naturally command higher fees.

3. Hospital and City:

   • Hospital Type: Costs differ between government hospitals, private multi-specialty hospitals, and specialized clinics. Private and corporate hospitals, especially those with NABH or JCI accreditation, offer premium facilities and services, which reflect in higher costs.
   • Geographical Location: Myomectomy costs are generally higher in major metropolitan cities like Mumbai, Delhi, Bangalore, Chennai, and Hyderabad compared to Tier 2 or Tier 3 cities, primarily due to higher operational overheads and demand.

4. Severity of Condition and Fibroid Characteristics:

   • Size, Number, and Location of Fibroids: The complexity of the surgery increases with larger, more numerous, or deeply embedded fibroids, requiring more time, resources, and surgical expertise, thereby increasing the cost.
   • Complications: Any unforeseen complications during surgery can also add to the overall expense.

5. Hospital Stay and Room Type:

   • The duration of your hospital stay (which varies by procedure type) directly impacts the cost.
   • The choice of room (general ward, semi-private, private, or deluxe suite) significantly affects the daily accommodation charges.

6. Pre- and Post-Surgical Expenses:

   • Diagnostic Tests: Costs for initial consultations, blood tests, pelvic ultrasound, MRI, etc.
   • Anesthesia Fees: Based on the type of anesthesia (general anesthesia is common) and duration of the procedure.
   • Medications: Pre-operative medications (e.g., GnRHa injections), intra-operative medications, and post-operative pain relievers and antibiotics.
   • Consumables and Disposables: Costs of surgical supplies used during the procedure.
   • Follow-up Consultations: Post-operative check-ups.

Estimated Cost Ranges in India (in Indian Rupees - ₹ and approximate USD conversion)

It's crucial to understand that these are estimated ranges, and actual costs can vary. Always obtain a detailed, itemized quote from your chosen healthcare provider.

• Overall Myomectomy Cost in India:

  • Typically ranges from approximately ₹1,00,000 to ₹4,25,000 (approximately USD 1,200 to USD 5,100, using an exchange rate of 1 USD = 83 INR).

• Specific Procedure Cost Estimates:

  • Minimum Cost (for simpler cases, smaller cities, or government hospitals): Around ₹40,000 (approximately USD 480).
  • Average Cost (for a standard procedure in a good private hospital): Ranges from ₹93,000 to ₹2,40,000 (approximately USD 1,120 to USD 2,890).
  • Maximum Cost (for complex cases, robotic surgery, or top-tier hospitals in metro cities): Can go up to ₹4,25,000 (approximately USD 5,100).

• By Surgical Type:

  • Laparoscopic Myomectomy: Ranges from ₹45,000 to ₹3,50,000 (approximately USD 540 to USD 4,215).
  • Robotic-Assisted Myomectomy: Typically starts around ₹2,20,000 and can go significantly higher based on complexity and hospital (approximately USD 2,650+).
  • Hysteroscopic Myomectomy: Average cost is approximately ₹68,000 (approximately USD 820), but can vary based on fibroid size and number.

Important Advice for Patients:

• Get a Detailed Quote: Always request a comprehensive, itemized cost breakdown from the hospital or clinic.
• Discuss with Insurance: Check if your health insurance policy covers myomectomy and understand the extent of coverage, including any deductibles or co-pays.
• Payment Plans: Inquire about potential payment plans or financial assistance options if needed.

India's healthcare sector continues to offer world-class medical services at a fraction of the cost found in many Western countries, making it an attractive destination for procedures like myomectomy.

How Ayu Helps

Navigating a significant medical journey like myomectomy can be complex. Ayu, your trusted Indian medical records app, simplifies this process by allowing you to securely manage and access all your health information in one place. From storing diagnostic reports and surgical records to tracking appointments and medication schedules, Ayu empowers you with seamless access to your health data, facilitating informed decision-making and better post-operative care.

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Frequently Asked Questions (FAQ)

Here are answers to some common questions regarding myomectomy:

1. Is myomectomy a permanent solution for fibroids? Myomectomy removes existing fibroids, providing significant relief from symptoms. However, it does not prevent new fibroids from growing. The risk of recurrence varies, being higher for women who had multiple fibroids or are younger at the time of surgery. Regular follow-up with your gynaecologist is recommended.

2. How long does it take to recover from a myomectomy? Recovery time varies based on the type of procedure:

• Abdominal Myomectomy: Hospital stay of 2-4 days, full recovery typically 4-6 weeks.
• Laparoscopic/Robotic Myomectomy: Hospital stay of 1-2 days, full recovery 2-4 weeks.
• Hysteroscopic Myomectomy: Often an outpatient procedure, recovery in a few days to a week. Your doctor will provide specific post-operative instructions for your individual case.

3. Can I get pregnant after myomectomy? Yes, myomectomy is often performed specifically to improve fertility. By removing fibroids that interfere with conception or pregnancy, it significantly enhances the chances of successful pregnancy. It is generally advised to wait 3-6 months after surgery to allow your uterus to heal completely before attempting to conceive.

4. Is myomectomy an alternative to hysterectomy? Absolutely. Myomectomy is the preferred alternative for women who wish to retain their uterus, particularly those desiring future pregnancies or who want to avoid a hysterectomy for other personal or medical reasons. Hysterectomy involves the removal of the entire uterus, which is a permanent solution for fibroids but ends fertility.

5. What are the signs that my fibroids need to be removed? You should consider myomectomy if your fibroids are causing significant symptoms that impact your quality of life, such as:

• Heavy or prolonged menstrual bleeding leading to anemia.
• Severe pelvic pain, pressure, or discomfort.
• Frequent urination or difficulty emptying the bladder.
• Constipation.
• Infertility or recurrent miscarriages attributed to fibroids.
• Rapid growth of fibroids or suspicion of a rare cancerous change (leiomyosarcoma).

6. Will I need a C-section after myomectomy? Often, yes. Many women who have undergone myomectomy, especially for larger or deeply embedded fibroids, are recommended to have a Caesarean section (C-section) delivery. This is done to prevent stress on the uterine scar during labour contractions, which in very rare cases, could lead to uterine rupture. Your obstetrician will assess your specific situation and recommend the safest mode of delivery.

7. What is the difference between myomectomy and hysterectomy? The key difference lies in the preservation of the uterus. Myomectomy removes only the fibroids, preserving the uterus and thus the woman's fertility. Hysterectomy involves the surgical removal of the entire uterus, which is a permanent solution for fibroids but ends the possibility of future pregnancies.

8. Are there non-surgical options for fibroids? Yes, there are several non-surgical and minimally invasive options for managing fibroids, depending on their size, location, and symptoms:

• Medications: Hormonal therapies (e.g., GnRHa, progestins) can help manage symptoms like heavy bleeding and pain, and sometimes shrink fibroids temporarily.
• Uterine Fibroid Embolization (UFE): This procedure blocks the blood supply to the fibroids, causing them to shrink. It is an option for women who do not desire future pregnancies.
• High-Intensity Focused Ultrasound (HIFU): A non-invasive procedure that uses ultrasound energy to destroy fibroid tissue. Myomectomy is chosen when these alternative treatments are not effective, or when fertility preservation is a primary goal.