Hysteroscopic Myomectomy
Camera-guided removal of submucosal fibroids (FIGO Types 0–2) without abdominal incisions—planned to your symptoms, anatomy, and pregnancy goals.
Hysteroscopic myomectomy treats fibroids that project into the uterine cavity (submucosal; FIGO Types 0–2). A slender hysteroscope is passed through the cervix, saline gently opens the cavity, and a resectoscope loop or mechanical tissue removal device excises the fibroid from its base. There are no abdominal incisions, recovery is typically quick, and tissue is sent to pathology. This approach often improves heavy bleeding and may enhance implantation and pregnancy rates when cavity distortion is present.
Fast Facts About Hysteroscopic Myomectomy
Incisionless, outpatient procedure through the cervix
Best for submucosal fibroids (FIGO Types 0–2) that distort the cavity
May be staged if a large Type 2 fibroid extends deeply into the wall
Cramping/spotting for a few days; most return to work in 1–2 days
Specimen sent to pathology for confirmation
Who It May Help
- Heavy menstrual bleeding, clotting, or anemia
- Infertility or recurrent implantation failure with a cavity lesion
- Intermenstrual bleeding or persistent spotting
- Pelvic pressure from a fibroid bulging into the cavity
- IUD malposition or expulsion related to cavity distortion
How It Works
After cervical preparation and anesthesia selection, a small camera is advanced through the cervix while saline distends the uterine cavity. Under direct vision, we excise the fibroid at its base using a resection loop or a mechanical morcellation device designed for intrauterine use. We re-inspect to ensure a smooth cavity and hemostasis. Large or deeply implanted (Type 2) fibroids may require a staged approach to protect the surrounding myometrium.
Candidacy & Alternatives
Ideal candidates have submucosal fibroids confirmed by ultrasound, saline infusion sonography, or MRI. Hysteroscopic myomectomy does not treat non–cavity-distorting intramural or subserosal fibroids. Alternatives include medical therapy (e.g., LNG-IUD, combined hormonal methods, tranexamic acid), laparoscopic/open myomectomy for intramural or large/multiple fibroids, uterine artery embolization for bleeding control (often not preferred when future fertility is a priority), and endometrial ablation (not for those desiring pregnancy). We align the plan with your bleeding, pain, and fertility goals.
Hysteroscopic vs. Other Fibroid Treatments
Hysteroscopic Myomectomy
- Incisionless; removes cavity-distorting submucosal fibroids
- Quick recovery; targeted tissue removal
- May improve bleeding and fertility
- Not suited to non–cavity-distorting fibroids
Laparoscopic/Open Myomectomy
- Removes intramural/subserosal and very large/multiple fibroids
- Requires abdominal incisions and longer recovery
- Preserves uterus; future pregnancy planning needed
- Useful when disease extends beyond cavity
Uterine Artery Embolization (UAE)
- Shrinks fibroids by reducing blood flow
- No hysteroscopic resection; variable impact on fertility
- Good bleeding control for some patients
- Not first-line if pregnancy is a near-term goal
What to Expect
Most procedures take 20–60 minutes. You may feel cramping similar to period cramps afterward and have light spotting for several days. Many patients resume desk work in 1–2 days. Avoid intercourse, tampons, swimming, and hot tubs until cleared—often 3–7 days depending on bleeding and comfort. If a staged approach is planned, we will schedule the second session after the uterus heals.
Safety & Considerations
Expected effects include cramping and light bleeding. Uncommon risks include infection, heavier bleeding, uterine perforation, fluid overload from distension media, or intrauterine adhesions. For selected patients, we may use adhesion-reduction strategies (e.g., barrier gel or short course of estrogen) and schedule a follow-up cavity check. Pathology results guide any additional care.
Before Your Visit
- ✓Share recent ultrasound or saline sonogram reports (and MRI if done)
- ✓Ask whether to pause anticoagulants or supplements that affect bleeding
- ✓Arrange a ride home if sedation is planned
- ✓Use pads—not tampons—until spotting resolves
- ✓Call us promptly if fever, severe pain, or heavy bleeding occurs
Frequently Asked Questions
1Will removing a submucosal fibroid help fertility?
For many patients with cavity distortion, hysteroscopic removal improves implantation and pregnancy rates. Your broader fertility picture—age, ovarian reserve, tubes, and partner factors—also matters.
2How long is recovery?
Most people return to routine activities within 1–2 days. Cramping typically settles within 24–48 hours, with spotting tapering over several days.
3Can fibroids come back?
New fibroids can develop over time, and residual deep portions of a Type 2 fibroid may need a second-stage resection. Ongoing follow-up helps address any recurrence of symptoms.
4Is anesthesia required?
Options range from local with oral medications to IV sedation or light general anesthesia, based on comfort, fibroid size/location, and whether additional steps are planned.
5Is endometrial ablation a substitute for myomectomy?
Ablation can reduce bleeding but does not remove fibroids and is not recommended for those desiring future pregnancy. When fertility is a goal, targeted removal of cavity-distorting fibroids is preferred.
6When can I resume intercourse or exercise?
After spotting resolves and you feel comfortable—often within 3–7 days—unless we advise otherwise based on the extent of resection.
Ready for Precise, Incisionless Fibroid Removal?
We'll confirm candidacy, remove cavity-distorting fibroids under direct visualization, and provide clear aftercare so you can get back to feeling well quickly.
Book an Appointment