Myomectomy (Fibroid Removal Surgery)

Introduction

Myomectomy is the surgical removal of uterine fibroids while leaving the uterus in place. If you have been diagnosed with fibroids and are now thinking about treatment, you are probably weighing several options — medications, less invasive procedures, myomectomy, or hysterectomy — and trying to understand what each one involves.

Myomectomy is often the operation of choice for women who want to keep their uterus, whether because they hope to become pregnant in the future or for personal reasons. It is a well-established procedure with several different surgical approaches, each suited to a different fibroid situation. This article walks through what myomectomy is, when it is used, the alternatives, the different ways it can be performed, what recovery looks like, and what to expect over the longer term.

What Is Myomectomy?

Myomectomy is the surgical removal of one or more fibroids from the uterus. Fibroids — also called uterine leiomyomas or simply myomas — are benign (non-cancerous) growths made of smooth muscle and fibrous tissue that develop in or on the wall of the uterus. They are very common: by age 50, a large proportion of women have had at least one fibroid, although many cause no symptoms at all.

The defining feature of myomectomy is that it preserves the uterus. The surgeon removes the fibroid tissue and then repairs the uterine wall, leaving the organ intact. This is what distinguishes myomectomy from hysterectomy, in which the whole uterus is removed. For women who wish to preserve fertility or keep the uterus for other reasons, myomectomy is the operation that allows fibroids to be addressed while still leaving pregnancy biologically possible.

Fibroids vary widely in size, number, and location. A woman may have a single small fibroid or many large ones. They may sit just under the inner lining of the uterus (submucosal), within the muscular wall (intramural), on the outer surface (subserosal), or hanging from a stalk (pedunculated). The location and size strongly influence which surgical approach is suitable.

Why Is Myomectomy Performed?

Most women with fibroids do not need surgery. Myomectomy is considered when fibroids are causing significant problems that have not responded to other measures, or when the fibroids themselves are interfering with fertility or pregnancy.

Common reasons doctors recommend myomectomy include:

• Heavy or prolonged menstrual bleeding that is leading to anaemia, fatigue, or a significant disruption of daily life. Submucosal and intramural fibroids are the most common culprits.
• Pelvic pain or pressure caused by large fibroids pressing on surrounding structures.
• Bladder or bowel symptoms such as frequent urination, difficulty emptying the bladder, or constipation, when fibroids are pressing on these organs.
• Fertility concerns, particularly when a fibroid distorts the uterine cavity (most clearly with submucosal fibroids) or when other causes of infertility have been ruled out.
• Recurrent pregnancy loss that may be linked to fibroid position or size.
• Rapidly enlarging fibroids or fibroids causing diagnostic uncertainty, where a doctor wants to remove and examine the tissue.

According to ACOG (the American College of Obstetricians and Gynecologists), management of fibroids should be guided by the patient’s symptoms, her reproductive plans, the size and location of the fibroids, and her own preferences. Surgery is one option among several, and the decision is individual.

Who Is a Candidate for Myomectomy?

Myomectomy may be appropriate when:

• Fibroids are causing significant symptoms (heavy bleeding, pain, pressure, fertility problems).
• You want to preserve your uterus, whether for future pregnancy or other personal reasons.
• The fibroids are technically removable — that is, their number, size, and location make surgical removal feasible without unacceptable risk to the uterus.
• You are in good enough general health to undergo surgery and anaesthesia.

Several factors may make myomectomy more difficult or push the conversation toward another approach:

• A very large number of fibroids or extremely large fibroids, where complete removal may not leave a structurally sound uterus.
• Fibroids in locations that are hard to reach safely.
• Suspicion of a cancerous growth (rare, but a possibility a surgeon will assess before surgery).
• Severe anaemia from prolonged heavy bleeding, which may need to be corrected before surgery.

Whether myomectomy is the right choice for any individual is a clinical conversation with a gynaecologist who knows the specifics of the fibroids, the symptoms, and the patient’s overall goals.

Alternatives to Myomectomy

Because fibroids are common and treatments vary widely in invasiveness, it is worth understanding the full range of options. Major societies including ACOG and RCOG emphasise that surgery is one option, not the only one, and that less invasive treatments should be considered when appropriate.

Watchful Waiting

If fibroids are not causing symptoms or are causing only mild ones, monitoring without treatment is a reasonable approach. Many fibroids stay stable for years, and most shrink after menopause when oestrogen levels fall.

Medications

Several medications can help manage symptoms, although they do not remove fibroids:

• Tranexamic acid taken during menstruation to reduce heavy bleeding.
• Non-steroidal anti-inflammatory drugs (NSAIDs) for pain and to modestly reduce bleeding.
• Hormonal contraceptives (combined pills, progestin-only pills, the hormonal IUD) to control bleeding patterns.
• GnRH agonists and antagonists, which lower oestrogen and can shrink fibroids and reduce bleeding. These are usually used short-term, often to improve anaemia or reduce fibroid size before surgery.

Uterine Artery Embolisation (UAE)

Also called uterine fibroid embolisation, this is a minimally invasive procedure performed by an interventional radiologist. Small particles are injected through a catheter into the arteries supplying the fibroids, cutting off their blood flow and causing them to shrink. UAE avoids open surgery and has a shorter recovery, but it is generally not the preferred option for women actively trying to conceive, because the effects on future fertility and pregnancy are less well established than with myomectomy.

MRI-Guided Focused Ultrasound and Radiofrequency Ablation

These newer techniques use heat (delivered by ultrasound waves or radiofrequency energy) to destroy fibroid tissue. Availability varies, and they are generally reserved for selected patients with specific fibroid characteristics.

Endometrial Ablation

This destroys the lining of the uterus to control heavy bleeding. It does not remove fibroids and is not suitable for women who want to preserve fertility.

Hysterectomy

Removal of the uterus is the definitive treatment for fibroids — they cannot come back if the uterus is gone. Hysterectomy may be considered when fibroids are very extensive, when symptoms are severe, when childbearing is complete, or when the woman prefers a one-time solution. It is not suitable for women who wish to retain the possibility of pregnancy.

Choosing between myomectomy and these alternatives depends on the size, number, and location of the fibroids, on symptom severity, on fertility goals, and on personal preference. A frank discussion with a gynaecologist is essential.

Surgical Approaches to Myomectomy

Myomectomy can be performed in several ways. The right approach for any individual depends mainly on the size, number, and location of the fibroids, on prior abdominal surgeries, and on the surgeon’s experience with each technique. The four main approaches are described below.

Hysteroscopic Myomectomy

Hysteroscopic myomectomy is used for submucosal fibroids — those that bulge into the uterine cavity. The surgeon passes a thin, lighted instrument called a hysteroscope through the vagina and cervix into the uterus. No abdominal incisions are needed. Specialised cutting or shaving instruments are introduced through the hysteroscope to remove the fibroid in pieces.

This is the least invasive form of myomectomy. Most women go home the same day and return to normal activities within a few days to a week. It is generally suitable when the fibroid is small to medium in size, predominantly inside the cavity, and limited in number. Surgeons typically assess these features beforehand with ultrasound, saline-infusion ultrasound, or MRI.

Laparoscopic Myomectomy

Laparoscopic myomectomy is a minimally invasive abdominal approach. The surgeon makes several small incisions (usually 0.5 to 1 cm) in the abdomen, inflates the abdomen with carbon dioxide gas to create working space, and inserts a camera (laparoscope) and instruments through the incisions. The fibroids are cut out of the uterine wall and the uterus is then stitched closed in layers using long instruments.

Once removed, the fibroid tissue needs to be taken out of the abdomen. This is often done using a process called morcellation, in which the fibroid is cut into smaller pieces. Following safety guidance from regulatory agencies including the U.S. FDA, power morcellation is now generally performed inside a containment bag to reduce the small risk of spreading tissue (including the rare possibility of an undiagnosed cancer) within the abdomen.

Laparoscopic myomectomy offers smaller scars, less pain, shorter hospital stay (often one day), and faster return to activity compared with open surgery. It is well suited for a limited number of fibroids of moderate size, although experienced surgeons can manage larger or more numerous fibroids laparoscopically.

Robotic Myomectomy

Robotic myomectomy is a variation of the laparoscopic approach. The surgeon controls robotic arms from a console, and the instruments at the patient’s side replicate the surgeon’s hand movements with greater precision and a wider range of motion. The view is three-dimensional and magnified.

The benefits to the patient are similar to standard laparoscopic surgery — small incisions, less pain, faster recovery. The technical advantages mainly help the surgeon perform fine work such as the multi-layered repair of the uterine wall, which is important for women planning future pregnancies. Major surgical societies note that outcomes with robotic and conventional laparoscopic myomectomy are broadly similar in skilled hands; the choice often depends on surgeon experience and equipment availability.

Open (Abdominal) Myomectomy

Open myomectomy, also called abdominal myomectomy, is performed through a single larger incision in the lower abdomen — usually a horizontal “bikini-line” cut, similar to a caesarean section incision, or sometimes a vertical incision for very large fibroids. The surgeon works directly on the uterus with conventional instruments.

This approach is generally chosen when fibroids are very large, very numerous, or in difficult locations where laparoscopic surgery would be unsafe or impractical. It allows the surgeon to feel the uterus directly, which can help identify smaller fibroids deep within the muscle, and it gives the most flexibility for a strong multi-layered repair of the uterine wall — an important consideration for women planning future pregnancy.

Hospital stay is typically two to three days, and full recovery takes longer than with minimally invasive approaches — usually four to six weeks before returning to normal activities.

How the Approach Is Chosen

Surgeons typically consider:

• Fibroid location. Submucosal fibroids inside the cavity are usually addressed hysteroscopically. Intramural and subserosal fibroids are addressed abdominally (laparoscopically, robotically, or open).
• Fibroid size and number. Smaller and fewer fibroids generally lend themselves to minimally invasive approaches.
• Previous surgery. Scar tissue from prior operations may influence the approach.
• Fertility plans. Approaches that allow the strongest uterine repair may be preferred for women planning pregnancy.
• Surgeon expertise. Experience with each technique varies between surgeons.

It is reasonable to ask the surgeon why they are recommending a particular approach and what alternatives were considered.

Preparing for Myomectomy

Preparation for myomectomy usually begins several weeks before the operation.

Investigations

The surgeon will want a clear picture of the fibroids. This typically involves:

• Pelvic ultrasound — the first-line imaging test.
• MRI — often used for surgical planning when fibroids are large, numerous, or in complex locations. MRI provides excellent detail of fibroid size, position, and relationship to surrounding structures.
• Saline-infusion sonography or hysteroscopy — to assess fibroids inside the cavity.
• Blood tests including a full blood count to check for anaemia.

Treating Anaemia Before Surgery

Heavy menstrual bleeding from fibroids often causes anaemia. Going into surgery anaemic increases the chance of needing a blood transfusion. Doctors commonly correct anaemia beforehand with iron supplements (oral or intravenous) and, in some cases, by using medication to temporarily stop menstrual bleeding for a few months.

Shrinking Fibroids Before Surgery

For very large fibroids, a course of GnRH analogue medication may be given before surgery. This temporarily reduces oestrogen, shrinks the fibroids, and reduces blood flow. This can make surgery technically easier and reduce blood loss. The medication is short-term and is stopped after surgery.

General Preparation

• You will be asked about all medications and supplements you take. Blood thinners, including over-the-counter products such as aspirin and certain herbal supplements, may need to be paused.
• If you smoke, stopping — even for a few weeks — helps reduce surgical complications.
• You will be told when to stop eating and drinking before surgery (usually from midnight the night before).
• You may receive instructions about bowel preparation, although this is not always needed.
• Arrange for someone to help you at home for the first few days, especially after open surgery.

What Happens During Myomectomy

The details of the operation depend on the approach. The broad steps, however, are similar.

Anaesthesia

Most myomectomies are performed under general anaesthesia. You are asleep and feel nothing during the operation. In some cases, particularly for short hysteroscopic procedures, regional anaesthesia (spinal or epidural) may be used instead.

Access and Visualisation

The surgeon gains access to the uterus by the chosen route — through the vagina and cervix (hysteroscopic), through small abdominal incisions with a camera (laparoscopic or robotic), or through a single larger abdominal incision (open).

Removing the Fibroids

An incision is made into the uterine wall over each fibroid. The fibroid is separated from the surrounding muscle and removed. For hysteroscopic surgery, the fibroid is shaved or cut away from inside the cavity. For abdominal approaches, the fibroid is enucleated — lifted out of its bed in the uterine wall.

Bleeding from the fibroid bed is controlled. Several techniques may be used to reduce blood loss during the operation, including injection of vasoconstrictor medications, temporary clamping of blood supply, and careful surgical technique.

Repairing the Uterus

This step matters greatly for women who may become pregnant in future. The uterine wall is closed in layers using absorbable stitches. A strong, well-aligned repair lowers the risk of uterine rupture during a future pregnancy. The surgeon’s experience with multi-layer closure is one of the reasons certain approaches may be chosen for women planning pregnancy.

Tissue Removal

For abdominal approaches, the removed fibroid tissue is taken out of the body. In open surgery this is straightforward. In laparoscopic and robotic surgery, larger fibroids are typically morcellated within a containment bag and removed through one of the small incisions, or through a slightly extended incision.

Duration

Hospital Stay

• Hysteroscopic myomectomy: usually a day case — home the same day.
• Laparoscopic or robotic myomectomy: often one night in hospital, sometimes a same-day discharge.
• Open myomectomy: typically two to three nights in hospital.

The First Week

Expect some pain at the incision sites or in the lower abdomen, controlled with painkillers prescribed at discharge. After laparoscopic surgery, shoulder tip pain from the carbon dioxide gas is common for a day or two. Vaginal bleeding or spotting is normal for one to several weeks after the procedure.

Walking is encouraged early on — it reduces the risk of blood clots and helps recovery. Heavy lifting, strenuous exercise, and driving should be avoided in the early period; the surgeon will give specific guidance.

The First Few Weeks

Return to light activities and desk-based work is usually possible within:

• A few days for hysteroscopic surgery.
• One to two weeks for laparoscopic and robotic surgery.
• Three to six weeks for open surgery.

Full recovery — including return to vigorous exercise and heavy lifting — typically takes four to six weeks for minimally invasive surgery and six to eight weeks for open surgery.

Follow-up

A follow-up visit is usually scheduled two to six weeks after surgery to check healing and discuss findings. The removed tissue is sent to pathology to confirm the diagnosis of fibroids. If imaging is needed to confirm healing of the uterine wall, this may be done a few months later, particularly if pregnancy is planned.

Trying to Conceive After Surgery

Doctors generally advise waiting before trying to conceive, to allow the uterine wall to heal fully. The recommended interval varies with the type and extent of surgery but is commonly three to six months. Your surgeon will give individualised guidance based on how many fibroids were removed, how deeply they extended into the wall, and how the repair was done.

Risks and Complications

Myomectomy is generally a safe operation, but as with any surgery there are risks. Knowing them helps with informed consent and post-operative awareness.

General Surgical Risks

• Bleeding. Myomectomy can involve significant blood loss, particularly when multiple or large fibroids are removed. A blood transfusion is sometimes needed, although measures are taken during surgery to minimise this risk.
• Infection of the wound, uterus, or pelvis. Antibiotics are commonly given around the time of surgery.
• Blood clots in the legs or lungs (DVT/PE). Early mobilisation and, when indicated, blood-thinning injections reduce this risk.
• Damage to nearby organs such as the bladder, ureters, or bowel. This is uncommon but possible, particularly with large fibroids or scar tissue from previous surgery.
• Anaesthetic complications.

Risks Specific to Myomectomy

• Conversion to hysterectomy. Very rarely, severe bleeding or other findings during surgery may make removing the uterus the safest option. This is uncommon but is discussed during consent.
• Recurrence of fibroids. New fibroids can grow after surgery, and small fibroids that were not removed may enlarge over time. The risk of recurrence rises over the years and is higher when many fibroids were present originally.
• Adhesions (scar tissue). Internal scar tissue can form after any abdominal surgery and may contribute to pain or fertility problems later.
• Uterine rupture in a future pregnancy. The repaired uterine wall is not quite as strong as an unoperated one. Rupture is rare but is a recognised risk during pregnancy or labour after myomectomy, especially if the surgery involved deep cuts into the muscle. For this reason, many obstetricians plan caesarean delivery rather than vaginal birth after significant myomectomy.
• Tissue spread with morcellation. When fibroids are morcellated in laparoscopic or robotic surgery, there is a small risk of spreading fragments of tissue within the abdomen. If a fibroid unexpectedly contains a hidden cancer (a rare event), this could spread the cancer. The use of containment bags during morcellation and careful pre-operative assessment are designed to reduce this risk.

How Surgeons Reduce Risk

Pre-operative anaemia correction, careful imaging, intra-operative measures to minimise blood loss, antibiotic prophylaxis, blood-clot prevention, and meticulous closure of the uterine wall all contribute to safer outcomes. Outcomes are generally better in centres and with surgeons that perform myomectomy regularly.

Life After Myomectomy

For most women, myomectomy provides good and lasting relief from the symptoms that prompted surgery. The longer-term picture has several important aspects.

Symptom Relief

Heavy bleeding usually improves substantially after fibroids are removed, particularly when the offending fibroids were submucosal or distorting the cavity. Pressure symptoms ease as the uterus returns to a more normal size. Pain that was clearly fibroid-related typically improves; pain from other causes (such as endometriosis or adenomyosis) is not addressed by myomectomy.

Fertility After Myomectomy

For women whose fertility was affected by fibroids — especially submucosal fibroids that distorted the cavity — myomectomy can improve the chances of conceiving and of successful pregnancy. The benefit depends on whether fibroids were the main cause of infertility and on the woman’s age and overall reproductive health.

Whether myomectomy improves outcomes is more nuanced for intramural fibroids that do not distort the cavity. Major societies, including ACOG and ESHRE, note that the evidence is mixed and that the decision should be individualised.

Pregnancy and Delivery After Myomectomy

Pregnancy after myomectomy is usually managed by an obstetrician familiar with the surgical history. Depending on how deep the cuts into the uterine wall were and how many fibroids were removed, your obstetrician may recommend planned caesarean delivery to reduce the risk of uterine rupture during labour. The exact plan depends on the operative notes from your myomectomy — one reason to keep a copy of your surgical report.

Fibroid Recurrence

Fibroids can come back after myomectomy. Some of this is true new growth; some is the enlargement of small fibroids that were too small to detect or remove at the time of surgery. Recurrence becomes more likely with each passing year and is more common in women who had many fibroids removed. Most recurrences do not require further surgery, but a minority of women eventually have a second operation.

Menstrual and Hormonal Effects

Myomectomy does not remove the ovaries, so it does not cause menopause. Hormonal cycles continue normally. Menstrual bleeding generally returns to a lighter, more typical pattern within a few cycles after surgery.

Frequently Asked Questions

How long does it take to recover from myomectomy?

Recovery depends on the approach. Hysteroscopic surgery allows return to normal activity within a few days. Laparoscopic and robotic surgery typically allow return to most activities within one to two weeks and full recovery in four to six weeks. Open surgery requires four to six weeks before light activities and up to eight weeks for full recovery. Your surgeon will give guidance based on what was done.

Can fibroids come back after myomectomy?

Yes. Fibroids can regrow, and small fibroids not removed at surgery can enlarge over time. The risk of recurrence rises with the years after surgery and is greater when many fibroids were originally present. Most women do not need a second operation, but some do.

Will myomectomy help me get pregnant?

If fibroids are the main barrier to pregnancy — particularly submucosal fibroids that distort the uterine cavity — myomectomy can improve fertility. If other factors are involved, fertility outcomes depend on those factors as well. A fertility evaluation alongside surgical planning is often helpful.

Will I need a caesarean section after myomectomy?

Possibly. If the surgery involved deep entry into the muscular wall of the uterus or the removal of several fibroids, your obstetrician may recommend planned caesarean to reduce the risk of uterine rupture during labour. The decision depends on the operative notes from the myomectomy. Keep a copy of your surgical report for future obstetric care.

Is myomectomy better than hysterectomy?

Neither is universally better — they answer different questions. Myomectomy preserves the uterus, allowing future pregnancy and avoiding removal of the organ, but fibroids can recur. Hysterectomy is definitive: fibroids cannot return because the uterus is gone, but pregnancy is no longer possible. The right choice depends on age, fertility goals, severity of symptoms, and personal preference. This is a conversation to have with a gynaecologist.

How is the surgical approach chosen?

Surgeons consider the location, size, and number of fibroids, previous abdominal surgeries, fertility plans, and their own experience with each technique. Submucosal fibroids inside the cavity are usually treated hysteroscopically. Other fibroids are removed through laparoscopic, robotic, or open surgery, depending on complexity.

How long should I wait before trying to conceive?

Doctors commonly advise waiting three to six months after myomectomy, depending on the depth of the uterine repair. Your surgeon will give individualised advice. Waiting allows the uterine wall to heal fully and reduces the risk of rupture in pregnancy.

Is morcellation safe?

Power morcellation in laparoscopic and robotic surgery carries a small risk of spreading tissue within the abdomen. To reduce this risk, surgeons now generally use containment bags during morcellation and carefully screen for any signs of cancer before surgery. The overall risk of an unsuspected cancer in a fibroid is low, but it is one of the factors discussed during informed consent.

Will my periods change after myomectomy?

For most women whose heavy bleeding was caused by fibroids, periods become lighter and more manageable after surgery. The ovaries are not affected, so the hormonal cycle and the timing of menopause are unchanged.

Conclusion

Myomectomy is a well-established option for women with symptomatic fibroids who want to preserve their uterus. It has several surgical approaches — hysteroscopic, laparoscopic, robotic, and open — each suited to different fibroid situations, and each with its own recovery profile and trade-offs. Alternatives ranging from medication to uterine artery embolisation to hysterectomy mean that surgery is one option among several, and the right choice is highly individual.

Understanding the operation, the alternatives, what recovery involves, and the longer-term implications for fertility and fibroid recurrence helps you have a more informed conversation with your gynaecologist. The decisions about whether to have surgery, which approach to use, and how to plan for the future are clinical ones, made together with a doctor who knows the details of your fibroids and your goals.