Hysteroscopic Myomectomy: Minimally Invasive Fibroid Removal

What Is a Hysteroscopic Myomectomy?

A hysteroscopic myomectomy is a procedure used to remove certain uterine fibroids from inside the uterus. It is performed using a thin camera called a hysteroscope, passed through the vagina and cervix. There are no abdominal incisions.

This approach is mainly used for submucosal fibroids, which are fibroids that protrude into the uterine cavity and commonly cause:

• Heavy menstrual bleeding

• Bleeding between periods

• Anaemia and fatigue

• Sometimes fertility or implantation concerns, depending on the case

For the right patient, this can be an effective form of fibroid removal with a relatively quick recovery.

Why Fibroid Location Matters

Fibroids are common, but they behave differently depending on where they sit:

• Fibroids within the uterine wall can cause pressure and pain

• Fibroids on the outer surface may cause bulk symptoms

• Fibroids inside the cavity often drive bleeding symptoms

Hysteroscopic myomectomy is designed for fibroids that are in or projecting into the cavity. If a fibroid is deep in the uterine muscle or outside the uterus, another treatment strategy may be more appropriate.

Who Is This Procedure Most Suitable For?

Hysteroscopic myomectomy may be considered if you have:

• Heavy periods that affect work, sleep, or daily life

• Bleeding that is persistent or worsening

• A confirmed submucosal fibroid on ultrasound or MRI

• Symptoms linked to a cavity-distorting fibroid

• A desire to preserve the uterus, where clinically suitable

It is not automatically the right option for every fibroid. A consultant assessment is essential to confirm whether the fibroid’s size, depth, and position make hysteroscopic treatment realistic and safe.

What Happens Before a Hysteroscopic Myomectomy?

Your consultant-led evaluation usually focuses on three things: diagnosis, suitability, and safety.

Confirming the fibroid type

Your consultant may use:

• Transvaginal ultrasound for detailed uterine assessment

• Saline infusion sonography in selected cases to clarify cavity distortion

• MRI if mapping needs more detail for planning

Checking your general health

Depending on symptoms, tests may include:

• Blood tests for iron deficiency and anaemia

• Review of medications, including anticoagulants

• Assessment of pregnancy plans and contraception

Planning the safest pathway

Some patients benefit from medication beforehand to improve conditions for surgery, depending on clinical factors. Your consultant will advise only if it is appropriate for you.

What Happens During the Procedure?

A hysteroscopic myomectomy is typically performed as a day-case procedure. The steps often include:

• A careful, consent-led preparation

• The hysteroscope is passed gently through the cervix

• Fluid is used to expand the cavity so the fibroid can be seen clearly

• The fibroid is removed using specialised instruments

• The uterine cavity is checked at the end of the procedure

Anaesthesia varies. Many operative hysteroscopic procedures are performed with anaesthetic support, and your consultant will explain what is appropriate for your case, including comfort and safety considerations.

What It Feels Like and Comfort Expectations

Because hysteroscopic myomectomy is an operative procedure, the experience differs from a purely diagnostic hysteroscopy.

After the procedure, it is common to have:

• Cramping, similar to period pain

• Light bleeding or spotting for a short period

• Tiredness for a day or two

Good care is not just technical. It is also how well your team prepares you for what is normal and what is not.

Benefits of Hysteroscopic Myomectomy

For suitable fibroids, hysteroscopic myomectomy can offer meaningful advantages:

• No abdominal cuts

• Often faster recovery than abdominal approaches

• Targeted treatment for fibroids that drive heavy bleeding

• Can improve quality of life when bleeding is the main symptom

• Uterus-preserving option when appropriate

The core point is selection. When the fibroid type fits the technique, outcomes can be very good.

Risks and Important Limitations

No clinic should pretend this is risk-free. The role of consultant care is to explain risks clearly and proportionately.

Potential risks can include:

• Bleeding

• Infection

• Cervical or uterine injury, including rare perforation

• Fluid-related complications during the procedure, managed with strict monitoring

• Incomplete removal if the fibroid is large or extends deep into the muscle

• Scar tissue within the uterus, which may require follow-up in selected cases

Fibroids can also recur over time, and new fibroids can develop. A successful procedure treats the fibroid that is causing symptoms, not the underlying tendency to form fibroids.

Recovery and Aftercare

Many patients return to normal activities quickly, but timelines vary. Your consultant will give individual guidance, but typical aftercare may include:

• Expect light bleeding or spotting for a short period

• Use simple pain relief if clinically suitable

• Avoid tampons and intercourse for a period advised by your clinician

• Follow-up to review symptom improvement and any histology results if tissue was sent for analysis

When to seek urgent medical advice

Seek urgent care if you develop:

• Heavy bleeding soaking pads rapidly

• Fever or chills

• Worsening pain not controlled with standard measures

• Offensive-smelling discharge

• Feeling faint or unwell

This is general information and does not replace personalised medical advice.

How This Fits Into Your Wider Fibroid Treatment Options

Hysteroscopic myomectomy is one option within a broader fibroid pathway. Depending on your symptoms, fertility plans, and fibroid pattern, your consultant may also discuss:

• Medical options to reduce bleeding

• Iron replacement if iron deficiency is present

• Alternative procedures for fibroids outside the cavity

• Monitoring when symptoms are mild and risk is low

The objective is not “more treatment”. The objective is the right treatment.

Hysteroscopic Myomectomy at LSDC Healthcare

At LSDC Healthcare in our Central London clinic, care is structured around consultant-led assessment, clear explanations, and a pathway that respects your time and privacy. If you are exploring fibroid removal, the first step is confirming whether your fibroid is the type that can be treated hysteroscopically, and whether this approach matches your goals and clinical needs.