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Why are Lupron injections given before a myomectomy procedure?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At January 16, 2023
Reviewed AtJanuary 17, 2024

Patient's Query

Hello doctor,

I am undergoing a laparoscopic myomectomy for three intramural fibroids of size 2.6 cm each, after two weeks. It is present in the anterior wall of the retroverted uterus. The doctor has not given any Lupron injection before surgery. My fibroids are not causing any symptoms. I had six IVFs (in vitro fertilization) and four IUI (intrauterine insemination) failures. So surgery is being performed because the fibroids are close to the cavity. I am taking a tablet of Levothyroxine 25 mg. So I have a few doubts.

  1. I had COVID eight months back. Will anesthesia be risky for me?
  2. What are the chances of death after laparoscopic myomectomy?
  3. What are the chances of it getting converted into an open myomectomy?
  4. How many days of bed rest are needed after surgery?
  5. How long can I take to conceive after surgery?
  6. Is my age a matter of concern for IVF?

Kindly give your suggestions.

Thank you.

Answered by Dr. Richa Agarwal

Hello,

Welcome to icliniq.com.

I read your query and understood your concern. The following are the answers to your questions:

1. No, anesthesia will not be very risky for you if you do not have major fibrosis due to COVID (coronavirus disease).

2. The risk of death in laparoscopic myomectomy is very minimal.

3. Your fibroid is small in size, so the chances of open myomectomy or uterus loss are very low.

4. Yes, it may increase the chances of pregnancy in your case.

5. At least seven to ten days of rest is required after surgery, and you can start routine activities after six to eight weeks.

6. You can plan your pregnancy after three to six months.

7. No, I suggest you go for genetic testing before planning pregnancy.

I hope this has helped you out. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hi doctor,

Thank you for your reply.

I am eager to undergo myomectomy surgery to restore fertility. But, my family members are worried about the pain and the risk of death during surgery. Kindly give your suggestions.

Thank you.

Answered by Dr. Richa Agarwal

Hi,

Welcome back to icliniq.com.

I understand your concern.

Laparoscopic myomectomy is a simple surgery, and no need to worry about it. The risk of death is very minimal in this surgery. You can convince your family with the help of your consulting doctor.

I hope this has helped you out.

Thank you.

Patient's Query

Hello doctor,

My laparoscopic myomectomy was successfully performed, and I am currently in good health. However, during the surgery, my cavity had to be opened to fully remove a one centimeter submucosal fibroid. Additionally, my right fallopian tube had to be clipped due to distal hydrosalpinx. I am considering moving forward with donor IVF. In this case, how long do I have to wait before attempting to conceive? Furthermore, is it possible to unclip the clipped tube? I lost my left fallopian tube due to hydrosalpinx 19 months ago, and at that time, my right tube was deemed normal. Is it common for hydrosalpinx to develop in the right tube within 19 months, especially considering it was normal previously? I am currently 38 years old and have been struggling with infertility for the past seven years. Kindly provide your opinion.

Answered by Dr. Richa Agarwal

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. You have to wait for at least six months before planning to conceive. If your hydrosalpinx improves, you can undergo the unclipping process. It is possible that your right tube has hydrosalpinx. Are you experiencing any symptoms like fever or pain? Are you currently taking any medication? I suggest you start taking folic acid tablets, recover properly, and then consider planning for conception. Ensure you maintain a high-protein diet and consume plenty of vegetables and fruits. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thanks for the reply doctor,

My doctor informed me that it was a laparoscopic myomectomy, but the cavity had to be opened to completely remove the fibroid. In this case, do I need to wait for six months before planning to conceive? What potential issues can arise from the cavity opening procedure? I am currently taking folic acid and Cholecalciferol IP 60,000 IU. Kindly provide your opinion.

Answered by Dr. Richa Agarwal

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. In that case, you can try after three months for pregnancy. There is no issue with the cavity opening, I was under the impression it was an open surgery. You can start walking after one and a half months and attempt to conceive after three months. Maintain a high-protein diet and consume plenty of vegetables and fruits. Consider having intercourse every alternate day between the 6th to the 16th day of your menstrual cycle. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thanks for the reply doctor,

Since my cavity was opened, can I expect heavy and crampy periods after myomectomy? I was not on any hormone medication before myomectomy since my fibroids were one to two centimeter in diameter. It has been 96 hours since my myomectomy, and there is still some mild spotting with occasional cramps. Is it possible for periods to come early due to this? What can be done to manage heavy periods after myomectomy? Before the procedure, my periods were normal, with minimal cramps, and my fibroids never caused symptoms. Can this change post-myomectomy? Kindly help.

Answered by Dr. Richa Agarwal

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. Periods are typically crampy and heavy due to fibroids, but they often become normal after myomectomy. In cases of fibroid recurrence, an IUD is usually recommended to prevent fibroids, heavy bleeding, and cramps. However, since you are trying to conceive, you cannot use it. Usually, periods do not change after myomectomy, you can expect your menses to arrive on time. However, sometimes periods may be affected. There is no need to worry excessively, you will likely resume your normal menstrual cycle after myomectomy. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Thanks for the reply doctor,

Today is my sixth day after laparoscopic myomectomy. Until now, I was spotting, but starting tonight, I am experiencing bright red blood (though not very heavy, and without period-like cramping). My last period was on one and a half month ago. What could be the reason for this bright red blood after 6 days, and what precautions should I take? Kindly help.

Answered by Dr. Richa Agarwal

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. This bright red blood in your case could be part of the cleaning process of the uterus after myomectomy surgery. There is no need to worry about it. Just ensure you get proper rest during your recovery period. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Richa Agarwal
Dr. Richa Agarwal

Obstetrics and Gynecology

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