A myomectomy is a surgical procedure that removes uterine fibroids while keeping the uterus intact. It’s the primary surgical option for people who have symptomatic fibroids but want to preserve their fertility or simply prefer to keep their uterus. Unlike a hysterectomy, which removes the entire uterus, a myomectomy targets only the fibroids themselves, leaving the surrounding tissue in place.
Why a Myomectomy Is Recommended
Fibroids are noncancerous growths in the uterine wall, and many people live with them without symptoms. A myomectomy enters the picture when fibroids start causing problems. The most common reasons include abnormal or heavy menstrual bleeding (sometimes severe enough to cause anemia), pelvic pain or pressure, and bulk-related symptoms like urinary urgency, frequent urination, or constipation from fibroids pressing on nearby organs.
Fertility is another major reason. Fibroids that distort the shape of the uterine cavity can significantly affect reproductive outcomes. The American Society for Reproductive Medicine recommends that cavity-distorting fibroids be surgically removed to improve pregnancy rates, even if the person has no other symptoms. For someone who has gone through multiple failed IVF cycles and has large fibroids within the uterine wall, myomectomy is strongly encouraged.
Three Types of Myomectomy
The right approach depends on where your fibroids are located, how many you have, and how large they are. There are three main options.
Abdominal (Open) Myomectomy
This involves a larger incision in the abdomen, similar to a cesarean section. It’s typically recommended when you have many fibroids or very large ones that can’t be safely handled through smaller incisions. It allows the surgeon the most direct access to the uterus but comes with a longer recovery.
Laparoscopic or Robotic-Assisted Myomectomy
Most myomectomies can be performed laparoscopically, even for quite large fibroids. The surgeon works through several small incisions using a camera and specialized instruments. A robotic-assisted version adds 3D visualization, greater instrument flexibility, and the elimination of natural hand tremor, which can make suturing and dissection more precise. Studies comparing the approaches show that both laparoscopic and robotic procedures result in less blood loss and shorter hospital stays than open surgery. Robotic myomectomy specifically has been associated with fewer blood transfusions compared to both laparoscopic and open approaches.
Hysteroscopic Myomectomy
This is the least invasive option. The surgeon passes a thin scope through the vagina and cervix into the uterus, with no abdominal incisions at all. It’s only an option for fibroids that grow into the uterine cavity (called submucosal fibroids), are smaller than about 4 centimeters, and don’t extend deep into the uterine wall. If your fibroids meet those criteria, hysteroscopic removal is often the first choice, particularly when fertility is a concern.
What Recovery Looks Like
Recovery time varies dramatically depending on which type of surgery you have. After a hysteroscopic myomectomy, full recovery can take just a few days. Laparoscopic procedures often allow you to go home the same day, with recovery at home taking about two to four weeks. Open abdominal myomectomy requires the longest healing period, up to six weeks before you’re back to normal activities.
Regardless of the approach, you’ll be advised not to lift anything heavier than 5 to 10 pounds during the first week (longer for open surgery) and to avoid sexual intercourse for six weeks. The key is a gradual return to activity rather than jumping back into your routine. Start slowly and pay attention to how your body responds.
Impact on Fertility and Pregnancy
For many people, preserving the ability to become pregnant is the entire reason for choosing myomectomy over hysterectomy. The evidence is encouraging. In one large study tracking outcomes after laparoscopic myomectomy, 523 pregnancies were recorded, resulting in 401 live births, a substantial success rate. The American Society for Reproductive Medicine endorses hysteroscopic myomectomy specifically for improving fertility and also supports other myomectomy approaches for fibroids that have a component extending into the uterine cavity.
Miscarriage rates after myomectomy vary across studies, and having had the procedure doesn’t eliminate that risk. Your surgeon will likely recommend waiting a certain period before attempting conception to allow the uterus to heal fully, particularly if the deeper layers of the uterine wall were repaired during surgery. The specific waiting period depends on the extent of the procedure.
Risks and Complications
Myomectomy is generally considered safe, with a low overall complication rate. The most significant risk is blood loss. Fibroids have their own blood supply, and removing them can cause heavy bleeding during surgery. If you already have anemia from heavy periods, your care team may work on building up your red blood cell count before the operation to reduce this risk.
Scar tissue formation (adhesions) is another concern. Any surgery on the uterus can create internal scarring that may affect future pregnancies or complicate later procedures. Minimally invasive approaches tend to produce less scar tissue than open surgery, which is one reason laparoscopic and hysteroscopic methods are preferred when feasible.
In rare cases, a myomectomy may need to be converted to a hysterectomy during surgery if bleeding can’t be controlled. This is uncommon, but it’s something surgeons discuss with patients beforehand.
Fibroids Can Come Back
One of the most important things to understand about myomectomy is that it doesn’t guarantee a permanent fix. Fibroids recur in roughly 15 to 33 percent of cases, and the numbers climb over time. Published recurrence rates range from 12 to 15 percent at one year, 31 to 43 percent at three years, and as high as 51 to 62 percent at five years. About 10 to 21 percent of women who have a myomectomy eventually undergo a hysterectomy within five to ten years because of recurring fibroids.
This doesn’t mean a myomectomy isn’t worthwhile. For someone who wants to have children, it can provide years of symptom relief during their reproductive window. But it’s worth going in with realistic expectations: the procedure removes existing fibroids, not the tendency to grow new ones. A hysterectomy remains the only definitive treatment that eliminates the possibility of recurrence entirely.
How Myomectomy Compares to Other Options
Myomectomy sits in a specific spot on the treatment spectrum. Medications can manage symptoms like heavy bleeding and shrink fibroids temporarily, but they don’t remove them. Procedures like uterine artery embolization cut off blood flow to fibroids and can shrink them without surgery, but they aren’t always recommended for people planning future pregnancies. Hysterectomy is the most definitive solution but ends the possibility of carrying a pregnancy.
Myomectomy is the option that addresses the fibroids directly while preserving the uterus. If you’re symptomatic and fertility matters to you, or if you simply want to keep your uterus, it’s the surgical approach designed for exactly that situation.