Hysteroscopic myomectomy is a minimally invasive surgical procedure used to remove fibroids (also known as myomas or leiomyomas) that develop inside the uterine cavity. Fibroids are benign (non-cancerous) growths that can cause symptoms like heavy menstrual bleeding, pelvic pain, infertility, and recurrent miscarriages. Among the different surgical options available for managing fibroids, hysteroscopic myomectomy is particularly effective for women who have submucosal fibroids—those that protrude into the uterine cavity.

This procedure has revolutionized the management of uterine fibroids because it avoids abdominal incisions, reduces hospital stay, and allows patients to return to their normal lives much faster compared to traditional open surgeries.

Understanding Submucosal Fibroids

Fibroids can grow in different locations within the uterus. They are classified into three main types:

Submucosal fibroids – located beneath the lining of the uterine cavity and projecting into it.

Intramural fibroids – embedded within the uterine wall.

Subserosal fibroids – projecting outside the uterus.

Submucosal fibroids, even when small, can cause significant symptoms because they distort the endometrial cavity. They are strongly associated with heavy menstrual bleeding, prolonged periods, infertility, and pregnancy complications. Hysteroscopic myomectomy is considered the gold standard treatment for symptomatic submucosal fibroids.

Indications for Hysteroscopic Myomectomy

Not all fibroids require removal. The decision depends on their size, number, location, and the symptoms they cause. Common indications include:

Heavy menstrual bleeding not controlled by medications.

Anemia due to excessive blood loss.

Infertility where submucosal fibroids distort the uterine cavity and interfere with implantation.

Recurrent miscarriages linked to fibroids.

Pelvic pain or pressure symptoms caused by fibroids projecting into the cavity.

The Procedure

Hysteroscopic myomectomy is usually performed as a day-care procedure under general or regional anesthesia. The key steps include:

Patient preparation – Medications like GnRH analogs may be given preoperatively to shrink fibroids and reduce vascularity.

Insertion of hysteroscope – A hysteroscope (a thin, lighted telescope) is inserted into the uterus through the vagina and cervix, avoiding the need for incisions.

Visualization of the cavity – The uterus is gently distended with a fluid medium (such as saline or glycine) to allow clear visualization.

Resection of fibroid – Using specialized instruments like a resectoscope with an electrical loop or a morcellator, the fibroid tissue is shaved away until the cavity is restored to its normal shape.

Completion – After removal, the uterine lining is inspected to ensure no residual fibroid tissue remains.

The duration of surgery depends on the size and number of fibroids, typically ranging from 30 minutes to 1 hour.

Benefits of Hysteroscopic Myomectomy

Minimally invasive – No abdominal incision is required.

Quick recovery – Most patients resume normal activities within a few days.

Preservation of fertility – The uterus is preserved, making this procedure suitable for women desiring future pregnancies.

Effective symptom relief – Significant improvement in heavy menstrual bleeding and chances of conception.

Reduced hospital stay – Often performed as an outpatient procedure.

Risks and Complications

While hysteroscopic myomectomy is generally safe, potential risks include:

Uterine perforation – Accidental puncture of the uterine wall.

Fluid overload – Excessive absorption of distending fluid.

Bleeding – Although usually minimal, rarely significant hemorrhage may occur.

Infection – Endometritis or pelvic infection.

Adhesion formation – Scar tissue (Asherman’s syndrome) may develop inside the uterine cavity.

Most of these complications are rare and can be minimized by experienced surgeons and proper patient selection.

Recovery and Postoperative Care

Patients are usually discharged the same day or the next morning.

Mild cramping, spotting, or watery discharge may persist for a few days.

Analgesics are prescribed to manage pain, if needed.

Sexual intercourse and tampon use are generally avoided for 2–3 weeks.

Follow-up hysteroscopy or ultrasound may be scheduled to confirm cavity healing.

Women seeking pregnancy can usually attempt conception after 2–3 menstrual cycles.

Success Rates

The success of hysteroscopic myomectomy largely depends on fibroid characteristics. Small, single, and pedunculated submucosal fibroids can often be removed completely in a single session, while larger or multiple fibroids may require staged procedures. Clinical studies show that:

Symptom relief (especially heavy bleeding) occurs in up to 80–90% of cases.

Fertility outcomes improve significantly, with many women able to conceive naturally or through assisted reproduction.

Conclusion

Hysteroscopic myomectomy is an advanced, minimally invasive surgical option for women suffering from symptomatic submucosal fibroids. By removing fibroids directly from the uterine cavity without external incisions, it provides excellent symptom relief, preserves fertility, and ensures rapid recovery. With growing expertise and modern instrumentation, this technique has become the preferred choice for managing fibroids that affect the uterine cavity.

Women experiencing heavy menstrual bleeding, infertility, or recurrent miscarriages due to fibroids should consult a gynecologist to explore whether hysteroscopic myomectomy is the right treatment option for them.