Once fibroids are removed they do not grow back. Therefore, the term “recurrence” is technically incorrect. Although new fibroids may grow after a myomectomy, most women will not require any additional treatment. If the first surgery is performed for a single fibroid, only 11% of women will have another surgery within the next 10 years. If multiple fibroids are removed, about 26% will have subsequent surgery. And the risks are lower for women as they get close to menopause, when new fibroids do not form. It would be extremely unusual for a woman to need another operation or procedure if she had a myomectomy after age 40.
Fibroids may be found after a myomectomy because the surgeon was not careful about removing all the fibroids during surgery. One ultrasound study found that 29% of women had fibroids left behind after myomectomy. There are very rare instances when so many (more than 100) very small fibroids are present and it becomes extremely difficult to remove them all. I have personally seen this situation only once.
While ultrasound can reliably find fibroids, many of them are very small and will not cause any symptoms. One ultrasound study, often quoted by gynecologists to encourage women to have a hysterectomy rather than a myomectomy, found fibroids ½ inch or larger in 51% of women 5 years after myomectomy. So, you may see this 50% number, but remember that it is not a meaningful statistic because very, very few of these women will need any further treatment.
What Can Increase or Decrease Your Risk of Getting New Fibroids After Myomectomy?
One study found that childbirth was the only factor that decreased the new appearance of fibroids after myomectomy: after 10-years, new fibroids were found in 16% of women who had given birth after surgery, but were found in 28% of women who had not given birth. The risk of new fibroids appearing increases with the number of fibroids removed, representing either fibroids left behind because the surgeon did not remove them all or, rarely, the result of a strong genetic tendency to form new fibroids.
Treatment with Lupron before surgery makes the fibroids smaller and may make them harder to identify and remove during surgery. One study found that after surgery 63% of the women treated with Lupron had small fibroids found with ultrasound, but only 13% of women who did not get Lupron had similar fibroids.
By William H. Parker, MD
Clinical Professor, Obstetrics and Gynecology, UCLA School of Medicine
Director of Minimally Invasive Gynecologic Surgery, UCLA Medical Center, Santa Monica
Page last updated: May 21, 2009