Topics of Interest

Petition – Residency Requirement Committee

As you know, I am a strong advocate for women who wish to preserve their uterus and have organ-conserving myomectomy procedures rather than hysterectomies.  

As it now stands, OB/GYN residency graduation requirements mandate that each Ob/Gyn resident perform 85 hysterectomies and exactly 0 myomectomies to go into practice. 

Two weeks ago, I submitted a petition, signed by 24 University Department Chairs and Residency Program Directors, to the OB/GYN Residency Review Committee asking the committee to mandate the teaching of myomectomy procedures to Ob/Gyn residents (the petition is below).  Last week, this petition was rejected by the Residency Review Committee. 

I think the pressure on the Residency Review Committee now has to come from women who have benefited from myomectomies, especially from women who have been told multiple times that hysterectomy was their only option. Many of you struggled to find a gynecologist to perform a myomectomy because most gynecologists are not being trained to perform this surgical procedure.  Nothing will change until the Residency Review Committee mandates a change in resident training.

If you are interested in joining together to inform the Residency Review Committee that you think this is an important issue, please respond to me at the email below and I will, with your permission, put you in touch with one another and you can figure out how you want to proceed.  Some of you belong to fibroid groups and, perhaps those women will be interested in this issue.  A petition on or a Facebook page occur to me, but you may have other, better ideas. 

I am happy to help this effort in any way I can.  But, for now, I will step out of the way and hope you can make this change happen for other women.  

Bill Parker, MD

Petition to the Residency Review Committee

We petition the RRC to require understanding and performance of myomectomy for completion of residency training.

Uterine fibroids are the indication for hysterectomy in 200,000 of the approximately 600,000 hysterectomies performed yearly in the United States.  Uterine fibroids are benign growths and they do not transform into malignant tumors. Obstetrics and Gynecology is the only specialty that routinely removes organs in their entirety due to the presence of benign growths.  

The use of hysterectomy for the treatment of fibroid-related symptoms is higher in the US than in France, England, Norway, and most other countries.  Myomectomy, an organ-conserving procedure, is under-utilized, accounting for only 30,000 procedures a year. It is often offered only to younger women who wish to preserve fertility.  

Our general surgical colleagues have accomplished a paradigm shift in organ-conservation for women with early-stage breast cancer, advancing from the Halstead radical mastectomy with axial lymphadenectomy to simple mastectomy with radiation to lumpectomy and lymphadenectomy to, currently, lumpectomy and sentinel node sampling.  These organ-preserving surgical advances are performed for women with invasive cancer.

Gynecologists increasingly use minimally-invasive surgery for fibroids, but the removal of the entire uterus is still the surgical goal.  In order to promote a paradigm shift toward organ-conservation, we must provide our residents with the skill set to perform myomectomies.  The RRC perpetuates this deficiency and ACGME requires 70 hysterectomies for completion of residency, but no myomectomies.

Myomectomy myths perpetuate the inadequate training of residents. Required training for “understanding and performance” of myomectomies will replace the myths and provide residents with the skills needed to offer myomectomy to women with fibroids confidently.

Myomectomy Myths:

Hysterectomy is safer than myomectomy.

Hysterectomy is associated with a greater risk of injury to other pelvic organs. Hysterectomy always requires dissection near the bladder, ureters, and the rectum, which increases the risk of injury. Myomectomy is performed inside the confines of the uterus and usually distant from those structures with documented decreased risk of injury to nearby organs. (Sawin, Iverson, Pundir)

Myomectomy is associated with more operative blood loss.

When matched for uterine size, the blood loss from myomectomy is no greater than for hysterectomy.  (cite) Current techniques have been shown to reduce blood loss further, including the use of a tourniquet, vaginal misoprostol, intravenous tranexamic acid and, vasopressin injected into the fibroid pseudo-capsule, as summarized in the Cochrane review. (Cochrane)

Fibroids will grow back following myomectomy

A meta-analysis of 7 studies with 872 women having 10 – 25 years of follow-up found that 89% did not require another surgery. (Fauconnier)   Older women are often denied myomectomies because “they no longer want children.” However, a study of women having myomectomies after age 45 followed for an average of 30 months found that only 1% required a hysterectomy for fibroid-related symptoms.

Your Uterus Will Look Like  Swiss Cheese After a Myomectomy

Following abdominal myomectomies, MRI with contrast shows complete healing of the myometrium and normal myometrial perfusion at 3 months.   Furthermore, three months after myomectomy uterine volume returned to normal volume. (Tsuji)

Hysterectomy with Ovarian Conservation Does Not Alter Your Hormones

Recent studies show persistently decreased AMH levels following hysterectomy despite ovarian conservation. (Wang)   Hysterectomy with ovarian conservation prior to age 50 has been associated with a significant increase in the risk of coronary heart disease, stroke, and heart failure.  (Ingelsson) While taking estrogen might obviate these adverse health effects, the vast majority of women who receive a prescription for estrogen following surgery are no longer taking it 5 years later.  

Myomectomy Will Not Improve Your Symptoms

For women with fibroid-related symptoms, open myomectomy has been shown to improve quality of life as measured by SF-36 scores. (Dilek)   European data shows a significant improvement in the quality of life (p<0.001) following laparoscopic myomectomy. (18)

Obstetrics and Gynecology is a women’s health specialty and women depend on us to advocate for women’s health.  Many women seek gynecologists who can perform myomectomy safely but are unable to find them. If the RRC does not believe myomectomy/uterine preservation is important for residents to learn, why should the residents think otherwise?    We are concerned about the lack of resident training for myomectomy and suggest that residents be required to perform 10 myomectomies (open, laparoscopic or robotic) in order to complete residency.

Respectfully signed,

William H. Parker, MD
Clinical Professor
Ob Gyn and Reproductive Sciences
UC San Diego School of Medicine

24 Ob/Gyn Department Chairs, Residency Directors and Program Directors from well-respected Universities also signed this petition.


Sawin SW, Pilevsky ND, Berlin JA, Barnhart KT. Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas. Am J Obstet Gynecol 2000;183:1448-55.

Iverson RE Jr, Chelmow D, Strohbehn K, et al. Relative morbidity of abdominal hysterectomy and myomectomy for management of uterine leiomyomas. Obstet Gynecol 1996;88:415–419.

Pundir J, Walawalkar R, Seshadri S, Khalaf  Y, El-Toukhy T. Perioperative morbidity associated with abdominal myomectomy compared with total abdominal hysterectomy for uterine fibroids. J Obstet Gynecol 2013;33:655-62  

Fauconnier A, Chapron C, Babaki-Fard K, Dubuisson JB. Recurrence of leiomyomata after myomectomy. Hum Reprod Update 2000;6:595-602.

Tsuji S, Takahashi K, Imaoka I, Sugimura K, Miyazaki K, Noda Y, Sudik.  MRI Evaluation of the Uterine Structure after Myomectomy. Eur J Obstet Gyn Reprod Biol 1996;65:209

Wang HY, Quan S, Zhang RL, Ye HY, Bi YL, Jiang ZM, Ng EH. Comparison of serum anti-Mullerian hormone levels following hysterectomy and myomectomy for benign gynaecological conditions. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2013;171:368-71.

Ingelsson E, Lundholm C, Johansson AL, Altman D. Hysterectomy and risk of cardiovascular disease: a population-based cohort study. Eur Heart J. 2011;32:745-50

Dilek S, Ertunc D, Tok EC, Cimen R, Doruk A. The effect of myomectomy on health-related quality of life of women with myoma uteri. J Obstet Gynaecol Res, 2010; 36: 364–9.

Radosa JC, Radosa CG, Mavrova R, Wagenpfeil S, Hamza A, Joukhadar R, Baum S, Karsten M, Juhasz-Boess I, Solomayer EF, Radosa MP.   Postoperative Quality of Life and Sexual Function in Premenopausal Women Undergoing Laparoscopic Myomectomy for Symptomatic Fibroids: A Prospective Observational Cohort Study. PLoS One. 2016 Nov 29;11(11)


Disclaimer: The ideas, procedures and suggestions contained on this web site are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision.

Fibroid Doctor William H. Parker

Dr. William H. Parker is a board-certified Fellow in the American College of Obstetricians and Gynecologists. Dr. Parker is an internationally recognized expert in fibroid surgery and research. Based in San Diego, California, he is considered one of the best fibroid surgeons for abdominal and laparoscopic myomectomy in the United States and abroad. He has been chosen for Best Doctors in America and Top Doctors every year beginning in the late 90's.

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