What follow-up questions should be asked to a 4-week post-myomectomy patient with a history of fibroids to assess their recovery progress and identify potential complications?

Post-Myomectomy Follow-Up Questions at 4 Weeks

At 4 weeks post-myomectomy, focus your assessment on identifying complications, evaluating recovery progress, and screening for early signs of recurrence or inadequate healing.

Pain and Discomfort Assessment

• Ask about current pain levels and location: Persistent or worsening pain may indicate hematoma formation, infection, or inadequate healing 1
• Inquire about pain character: Sharp, localized pain at the incision site versus diffuse pelvic pain helps differentiate surgical complications from other causes 2
• Assess analgesic requirements: Increasing need for pain medication beyond 4 weeks suggests complications 1

Bleeding Patterns

• Document menstrual bleeding if cycle has resumed: Return of heavy menstrual bleeding at this early stage may indicate incomplete fibroid removal or rapid recurrence 3
• Ask about abnormal vaginal bleeding or discharge: Persistent bleeding or foul-smelling discharge suggests infection or wound dehiscence 2
• Quantify bleeding volume: Use standardized measures (number of pads/tampons per day, presence of clots) 3

Return to Activities

• Determine when patient returned to usual daily activities: Expected median is 21-28 days for laparoscopic and abdominal approaches respectively 1
• Ask about return to work status: Median return is 22 days for laparoscopic and 42 days for abdominal myomectomy 1
• Assess physical activity limitations: Patients should avoid heavy lifting and strenuous exercise until 6 weeks minimum 4

Fever and Infection Screening

• Ask about fever episodes: Temperature >38°C suggests endomyometritis, abscess formation, or wound infection 2
• Screen for systemic symptoms: Chills, malaise, or night sweats indicate possible infection 2

Urinary and Bowel Function

• Inquire about urinary symptoms: Dysuria, frequency, or hematuria may indicate bladder injury or urinary tract infection 2
• Ask about bowel habits: Constipation, diarrhea, or pain with defecation can indicate bowel injury or adhesion formation 2

Wound Healing (for Abdominal Approach)

• Assess incision appearance and symptoms: Redness, warmth, drainage, or separation suggests wound infection or dehiscence 2
• Ask about incisional pain: Persistent or increasing pain at the incision site warrants examination 1

Thromboembolism Risk Assessment

• Screen for leg pain, swelling, or asymmetry: Venous thromboembolism is a recognized complication of myomectomy 2
• Ask about chest pain or shortness of breath: These symptoms require immediate evaluation for pulmonary embolism 2

Symptom Resolution

• Evaluate improvement in pre-operative symptoms: Heavy bleeding, pelvic pressure, or bulk symptoms should be improving by 4 weeks 1
• Ask about new or persistent symptoms: Lack of improvement or new symptoms may indicate incomplete fibroid removal or complications 1

Fertility Planning (if applicable)

• Discuss pregnancy timing: Patients must wait 2-3 months minimum before attempting conception to allow adequate uterine healing and minimize rupture risk 4
• Counsel on pregnancy possibility: Pregnancy is possible after myomectomy even if not desired 2

Psychological Well-being

• Assess anxiety levels: Laparoscopic myomectomy patients report more anxiety in early recovery compared to abdominal approach 1
• Screen for depression or emotional distress: Major surgery impacts mental health and recovery 1

Imaging Considerations

At 4 weeks, routine imaging is NOT indicated for asymptomatic patients 5. However, consider ordering transvaginal ultrasound combined with transabdominal ultrasound if:

• Patient reports persistent or worsening symptoms 5
• Clinical examination reveals concerning findings (pelvic mass, tenderness) 5
• Suspicion of hematoma, abscess, or incomplete healing 6

Note that complete uterine structural recovery takes 6-12 weeks on MRI, with myometrial stabilization at 6 weeks and endometrial stabilization at 12 weeks 6.

Red Flags Requiring Urgent Evaluation

• Severe or increasing abdominal pain: May indicate hematoma, abscess, or bowel/bladder injury 2
• Heavy vaginal bleeding: Requires immediate assessment for hemorrhage 2
• High fever with systemic symptoms: Suggests serious infection 2
• Signs of venous thromboembolism: Leg swelling, chest pain, dyspnea 2