Fibroid surgery is generally safe, with a mortality rate of roughly 0.013%, or about 1.3 per 10,000 patients. Major complications occur in fewer than 3% of cases, depending on the type of procedure. That said, “fibroid surgery” covers several different operations, and each carries its own level of risk. Understanding the differences can help you weigh your options clearly.
How Complication Rates Break Down by Procedure
The two main surgical approaches for fibroids are myomectomy (removing the fibroids while keeping the uterus) and hysterectomy (removing the uterus entirely). Within each, the method used to access the fibroids makes a significant difference in risk.
For hysterectomy performed for fibroids, the 30-day major complication rate is around 1.8% for minimally invasive or vaginal approaches and 2.8% for open abdominal surgery. Minor complications like infections or urinary issues run slightly higher, in the 3% to 4.5% range across all methods.
For myomectomy, the pattern is similar. Laparoscopic (keyhole) and robotic myomectomy carry a postoperative complication rate of about 7%, while open abdominal myomectomy sits closer to 10%. Those numbers include all complications, most of which are manageable and temporary. The key tradeoff: open surgery allows surgeons to remove more or larger fibroids, but it comes with more blood loss, longer hospital stays, and a slower recovery.
Blood Loss and Transfusion Risk
Bleeding is the most common concern during fibroid removal, because fibroids have their own blood supply. The overall blood transfusion rate across all myomectomy types is about 10%. That number varies sharply by approach: only 2.7% of laparoscopic patients need a transfusion, compared to 16.4% of those having open abdominal surgery. Hysteroscopic myomectomy, where fibroids inside the uterine cavity are removed through the vagina with no incisions, falls in between at around 6.7%.
Surgeons typically prepare for this possibility ahead of time. If you’re already anemic from heavy fibroid-related bleeding before surgery, your doctor may recommend iron supplements or other treatments in the weeks beforehand to build up your blood counts.
The Morcellation Question
During minimally invasive surgery, large fibroids sometimes need to be cut into smaller pieces to be removed through tiny incisions. This process, called power morcellation, raised serious safety concerns after cases emerged where it spread undetected cancer cells within the abdomen.
The FDA now recommends that power morcellation only be performed with a tissue containment system, essentially a bag that catches all the tissue fragments so nothing scatters inside the body. The agency also warns against using power morcellation in women who are postmenopausal or over 50, since the risk of an undetected uterine cancer (called occult cancer) increases with age. Even when fibroids look completely benign on imaging, a small percentage turn out to harbor cancerous cells that can’t be identified until after removal.
If your surgeon recommends a minimally invasive approach, it’s worth asking whether morcellation will be needed and whether a containment system will be used.
Pregnancy After Fibroid Surgery
Many people choose myomectomy specifically because they want to preserve their ability to have children. The good news: the risk of the surgical scar on the uterus rupturing during a future pregnancy is low. A review of over 3,500 deliveries after myomectomy found an overall uterine rupture rate of 0.6%. Among women who went through labor (rather than having a planned cesarean), the rate was even lower at 0.4%.
That said, most surgeons recommend waiting several months after myomectomy before trying to conceive, to give the uterus time to heal fully. The exact timeline depends on the size and location of the fibroids that were removed and whether the surgery cut deep into the uterine wall.
Recovery Time by Surgery Type
Recovery varies dramatically depending on how the surgery is performed. Hysteroscopic myomectomy, used for fibroids that grow into the uterine cavity, has the fastest turnaround. Most people recover within days.
Laparoscopic or robotic myomectomy typically means two to four weeks of recovery at home. Open abdominal myomectomy requires the longest healing period: a few days in the hospital followed by up to six weeks before you feel fully back to normal. During recovery from any approach, you should avoid lifting anything heavier than 5 to 10 pounds for at least the first week, and sexual intercourse is off limits for six weeks regardless of the surgical method.
Fibroids Often Come Back
One risk that surprises many people isn’t a surgical complication at all. It’s recurrence. Myomectomy removes existing fibroids but doesn’t prevent new ones from growing. The numbers are sobering: within five years of laparoscopic myomectomy, roughly 57% of patients show new fibroid growth on imaging. By eight years, that figure climbs to about 76%. Open myomectomy has slightly lower recurrence rates (around 47% at five years, 63% at eight years), possibly because surgeons can feel and remove smaller fibroids that might be missed with a camera.
Not all recurrences cause symptoms or require treatment. But about 8% to 15% of patients eventually need a second procedure. This is an important factor when deciding between myomectomy and hysterectomy, since hysterectomy eliminates the possibility of recurrence entirely.
How Nonsurgical Alternatives Compare
Uterine fibroid embolization (UFE) is a procedure where a radiologist blocks the blood vessels feeding the fibroids, causing them to shrink. Compared to open myomectomy, UFE is associated with shorter hospital stays, fewer blood transfusions, and similar long-term symptom improvement. Re-intervention rates after UFE run around 8%, compared to roughly 15% after abdominal myomectomy.
UFE isn’t a fit for everyone. It’s typically not recommended for women planning pregnancy, and it doesn’t work well for very large fibroids. But for those who want to avoid surgery altogether, it offers a lower-risk alternative with comparable results in symptom relief. Medication options also exist that can shrink fibroids or manage symptoms like heavy bleeding, though they don’t eliminate the fibroids permanently.
What Makes Surgery Riskier for Some People
Individual risk factors matter more than averages. Larger fibroids, a higher number of fibroids, and fibroids embedded deep in the uterine wall all increase surgical complexity and the chance of complications. Obesity, prior abdominal surgeries, and existing health conditions like diabetes or blood clotting disorders also raise the risk profile.
The surgical approach itself is one of the biggest modifiable risk factors. When minimally invasive surgery is an option, it consistently shows lower complication rates, less blood loss, and faster recovery than open procedures. The shift away from uncontained morcellation after the FDA’s warnings actually led to a slight increase in complication rates across the board, from 1.9% to 2.4% for major complications, because more surgeries were converted to open abdominal procedures. This tradeoff illustrates the balancing act between different types of risk.