Shaskia Mateo Encarnacion

Writing for the Sciences

Professor Zayas

April 2^nd 2025

Myomectomy vs Hysterectomy, Which Surgical Approach Is Better For Uterine Fibroids.

Introduction.

In today’s society the standard of care for every women is to get checked once a year at her local gynecologist to make sure their uterine health is as close to pristine as it can be, but even when being the most meticulous your body can still develop unhealthy conditions that can affect your daily life mentally and physically. Uterine Fibroids is one of these possible conditions that more often than none occur for no reason whatsoever. Fibroids are benign tumors that grow in the uterus and uterine wall but can be removed using two different surgical approaches, a Myomectomy or a Hysterectomy, and explicitly as scientists describe them “Fibroids are a mixture of smooth muscle cells and fibroblasts, which form hard, round, whorled tumours in the myometrium” (Lumsden, et al., 2025, pg 1). In this article, the various surgical options will be assessed to find which intervention ultimately maintains women’s QoL, subsequent fertility, and pregnancy results with the determination that in some cases, hysterectomy is the most guaranteed, permanent QoL intervention.

Myomectomy.

A Myomectomy is a surgical procedure that is done to remove uterine fibroids  in order to preserve the uterus. It can be done in three different ways, as open surgery, laparoscopically and hysteroscopy. Scientists often argue that a myomectomy is mostly performed in cases where women request it because they want to preserve their fertility since they want to create a family in the foreseeable future even though it is not proven that it improves fertility or pregnancy. This surgical procedure as any other can have little to no complications or major complications after surgery, that can affect women’s QOL (quality of life) and can even result in death. “Minor complications consisted of urinary tract infections and superficial surgical site infections (SSIs)” (Coyne et al., 2025). According to Coyne and other scientists involved in the article one of the most common minor complications were mild infections that healed in the span of a few days and can be manageable rather easily. When it comes to major complications “Major complications included blood transfusion intraoperatively or within 72 hours from the procedure, deep and organ/space SSI, wound disruption, pneumonia, unplanned intubation or ventilation for >48 hours, stroke, cardiac arrest, myocardial infarction, sepsis, septic shock, deep vein thrombosis, pulmonary embolism, acute kidney injury, return to the operating room, and death, all within 30 days of the index procedure” (Coyne et al., 2025). Scientists explain that major  complications can result in patients being transported back to the operating room for a follow up care surgery and can even result in death and many other complications all within 30 days of the initial procedure. There is also a 30% chance of a myomectomy resulting in a hysterectomy in order to try and save the patient from death. Even though myomectomies are proven to be rather successful, scientists still do not believe that it’s considered the best choice for preserving fertility. “ Despite growing appreciation regarding the impact of fibroid symptomatology, we are still limited by long-term treatment options for individuals wishing to maintain their uterus” (Coyne et al., 2025). 

Hysterectomy.

A Hysterectomy is a surgical procedure that removes the entire uterus, permanently resolving all issues with uterine fibroids. Hysterectomies are considered the ultimate solution for the removal of uterine fibroids, although one of the main reasons why women don’t choose it’s because they will be giving up their hope of becoming mothers. Scientists have proven that hysterectomies are the prime choice of uterine fibroids. “…hysterectomy was the most common intervention in women with uterine fibroids and adenomyosis” (Deipolyi, 2025). Deipolyi  explains that the condition of fibroids and adenomyosis are mostly resolved with hysterectomies because it is the most effective procedure due to its permanency resolving this issue. “Previous work has shown that surgical management of fibroids with hysterectomy is associated with greater QOL compared with myomectomy.” (Frish-Mitchell, et al.,2023) In comparison with Myomectomy, Hysterectomy has proven to be more effective due to less complications after surgery and a better quality of life, further proving that it’s the “better choice” for operating on uterine fibroids. 

 Comparing the surgical approaches: Myomectomy and Hysterectomy.

When deciding which surgical approach is better for the removal of uterine fibroids we quickly think about finding a permanent solution that will still give open decisions for different things in life such as starting a family and having children, for part of the female population of course. So in this case if Hysterectomies are a permanent solution but take away fertility and Myomectomies give the chance of having children but in most cases present many complications and the probability of fibroids growing again, how do we choose which one is better?. Well scientists comment that when it comes to Myomectomies they still don’t have it 100% resolved “ Despite growing appreciation regarding the impact of fibroid symptomatology, we are still limited by long-term treatment options for individuals wishing to maintain their uterus” (Coyne et al., 2025), making this option only work is some cases and not complementing to what some women desire. As I stated before Hysterectomies are the prime option for this condition but due to its termination of future or existing pregnancies many women decide on not getting it. If It’s a life or death situation in which this surgery is the only option to save them, they can be affected mentally in the future because it completely kills the Idea of birthing a child. On the other hand the Ideal operation also consists of the kind of fibroid that’s in the uterus, and more often than not, this is what makes Doctors decide what operation they will be performing. “Other reports have demonstrated that the number, size, and location of the fibroids as well as the mode of surgery can influence the risk of bleeding and other complications” (Coyne et al., 2025). In this article, Coyne and the other authors explained that the size and more factors of fibroids influences the complications after and during surgery, no matter what procedure is done, this is often considered when Fibroids are way to big or they’re located in parts of the uterus that are difficult to excise. 

Fertility and pregnancy issues with fibroids.

Additionally the issues that fibroids and these surgeries have on fertility and pregnancy is one of the main reasons why women opt to not have any procedures that might compromise their ability to have children or existing pregnancies, but due to the fibroids doctors have to weight the patients health as more important, despise some the wishes a woman may have. It has also been proven that In some cases fertility and fibroids can be completely unrelated, a patient could be infertile and then develop fibroids. “The effect of intramural fibroids is uncertain and current consensus does not support their removal to improve fertility” (Lumsden, et al., 2025, pg 4). Lumsden et al argues that when removing existing fibroids fertility does not improve or “get better” but it stays the same if it was not affected during surgery. 

When discussing an existing pregnancy and the appearance of fibroids together, it can put the mother and fetus at risk for excessive bleeding, pain and even losing the pregnancy, the mother or both. “pregnant women with fibroids, in comparison to pregnant women without them, are more likely to have premature uterine contraction (16.1% and 8.7% respec- tively) and premature delivery (16.0% and 10.8%)” (Fuchs et al.,2019). Fuchs et al prove that women pregnant with fibroids are more likely to have a high risk pregnancy than a pregnancy that does not have them. Even though fibroids are benign, they cause great pain and hold the space where there should be a baby which is one of the reasons it causes excessive bleeding, and other complications that might affect the baby. “Rarely, large myomas may deform the uterine cavity by causing compression, causing fetal deformities such as: dolichocephaly (due to lateral pressure on the skull of the fetus), torticollis (incorrect neck position in utero) and weakness of one of the limbs” (Fuchs et al.,2019).  Scientists have confirmed that due to the space fibroids (myomas) occupy in the uterus, during pregnancy these compressions can affect the baby and cause deformities. 

Conclusion.

Ultimately, the choice between a Myomectomy and a Hysterectomy will be determined based on the Individual’s health, reproductive goals and the location and size of Uterine Fibroids. While Hysterectomy is a permanent and often complication-free solution, it eliminates the possibility of future pregnancies. On the other hand, a Myomectomy preserves the uterus and gives a chance for fertility but has a high chance of fibroid recurrence and it has been proven that it can present many complications, sometimes ending in an emergency Hysterectomy. Physicians must consider and observe closely each woman’s condition and weight benefits and risks equally in order to be able to choose the right course of action for Women’s desires and quality of life. More research still needs to be done to find a solution that will satisfy everyone and will not affect patients mentally or physically in the long run. Until then, personalized decision making and teamwork between families and physicians remains as one of the most important factors for the removal of Uterine Fibroids.

References.

Coyne, Kathryn, et al. “Risk of Hysterectomy at the Time of Myomectomy: An Underestimated Surgical Risk.” Fertility and Sterility. Accessed March 18, 2025. www-sciencedirect-com.ccny-proxy1.libr.ccny.cuny.edu/science/article/pii/S0015028223018836.

Deipolyi, Amy R., et al. “Hysterectomy and Myomectomy vs. Uterine Artery Embolization for Symptomatic Fibroids and Adenomyosis: National and Regional Trends and Adverse Events in 70,000 Patients.” Journal of Vascular and Interventional Radiology. Elsevier, February 28, 2025. www.sciencedirect.com/science/article/abs/pii/S1051044325002180.

Frisch, Emily H., Jameson Mitchell Jameson, et al. “The Impact of Fertility Goals on Long-Term Quality of Life in Reproductive-Aged Women Who Underwent Myomectomy versus Hysterectomy for Uterine Fibroids.” Journal of Minimally Invasive Gynecology. Elsevier, April 10, 2023. www.sciencedirect.com/science/article/abs/pii/S155346502300153X.  

Fuchs, Anna, Agnieszka Dulska, Jerzy Sikora, Iwona Czech, Violetta Skrzypulec-Plinta, and Agnieszka Drosdzol-Cop. “Symptomatic Uterine Fibroids in Pregnancy — Wait or Operate? Own Experience.” Ginekologia Polska 90, no. 6 (2019): 320–24. https://doi.org/10.5603/GP.2019.0058 Lumsden, M. A., I. Hamoodi, T. Gupta, and M. Hickey. “Fibroids.” BMJ: British Medical Journal 351 (2015). Accessed March 17, 2025. https://www.jstor.org/stable/10.2307/26524114.