Evaluating the Long-Term Outcomes of Hysteroscopic Myomectomy in Women with Submucosal Myomas: A Retrospective Study

Abstract

Background: Submucosal fibroids are a major cause of abnormal uterine bleeding, anemia, pelvic pain, and infertility. Hysteroscopic myomectomy is the preferred minimally invasive treatment, but data on its long-term outcomes and reproductive benefits remain limited. This study aimed to evaluate the effectiveness, safety, and reproductive outcomes of hysteroscopic myomectomy in patients with submucosal myomas. Methods: A retrospective study was conducted on 327 women who underwent hysteroscopic myomectomy at Shahid Beheshti and Alzahra hospitals. Data on preoperative symptoms, intraoperative complications, postoperative outcomes, and follow-up were collected from medical records and phone interviews. Results: The mean age of patients was 43.2 ± 7.0 years. The most common presenting symptom was abnormal uterine bleeding (96%), followed by anemia (61.8%), pelvic pain (22.3%), infertility (14.1%), and urinary complaints (2.4%). Complication rates were low, with uterine perforation (0.3%), hemorrhage (1.8%), prolonged hospitalization (0.6%), and postoperative fever (0.3%) occurring infrequently. Repeat myomectomy was necessary in 7.6% of cases, while 10.7% required subsequent total laparoscopic hysterectomy (TLH). Overall, 70.6% of patients achieved complete symptom resolution, and 95.4% reported satisfaction with the procedure. Among 44 infertile women, 28 (63.6%) conceived after surgery, including 22 spontaneous and 6 assisted reproductive technology (ART) pregnancies. Conclusions: Hysteroscopic myomectomy is an effective and minimally invasive treatment for submucosal fibroids, offering substantial symptom relief, high patient satisfaction, and favorable fertility outcomes. With low complication and reoperation rates, it remains a valuable therapeutic option for women seeking both symptom control and fertility preservation.