Fibroid surgery is any procedure that removes or destroys uterine fibroids, the noncancerous growths that develop in or on the uterus. The two main categories are myomectomy, which removes fibroids while keeping the uterus intact, and hysterectomy, which removes the uterus entirely. The right choice depends on the size, number, and location of your fibroids, the severity of your symptoms, and whether you want to become pregnant in the future.
When Surgery Becomes Necessary
Small fibroids often don’t need treatment at all. Many people have them without knowing it. Surgery enters the conversation when fibroids cause problems that medications or watchful waiting can’t manage. The most common reasons include pain that becomes unmanageable, excessive menstrual bleeding, swelling in the abdomen or pelvis, and anemia from chronic blood loss. In rare cases, fibroids contribute to infertility, and removing them can improve the chances of conception.
Treatment decisions are driven by symptoms, not fibroid size alone. A large fibroid that causes no problems may not need surgery, while a smaller one pressing on the bladder or distorting the uterine cavity might. Your doctor will consider the number and placement of fibroids alongside your symptoms and reproductive goals before recommending a specific procedure.
Types of Myomectomy
Myomectomy removes fibroids while preserving the uterus. It’s the standard choice for people who want to keep the option of future pregnancy. There are three main approaches, each suited to different situations.
Hysteroscopic Myomectomy
This is the least invasive option. A thin instrument is passed through the vagina and cervix into the uterus, so there are no incisions on the abdomen at all. It works best for fibroids that grow inside the uterine cavity. Recovery takes about 48 hours, and most people return to work as soon as they feel ready.
Laparoscopic or Robotic Myomectomy
For fibroids on the outer wall of the uterus or embedded within the muscle, surgeons can operate through a few small abdominal incisions using a camera and specialized instruments. Robotic-assisted versions of this surgery use the same small incisions but give the surgeon enhanced precision. Compared to open surgery, robotic myomectomy is associated with less blood loss (roughly half) and a shorter hospital stay. Recovery typically takes two to three weeks.
Abdominal (Open) Myomectomy
When fibroids are very large, numerous, or deeply embedded, an open surgery through a larger abdominal incision may be necessary. This approach gives the surgeon the most direct access. The tradeoff is a longer recovery of four to six weeks and more blood loss during the procedure. Open myomectomy also tends to have a shorter operating time than laparoscopic surgery, which can matter when removing many fibroids at once.
Hysterectomy for Fibroids
Hysterectomy removes the uterus entirely and is the only procedure that guarantees fibroids won’t come back. It’s generally considered when fibroids are severe, other treatments have failed, or future pregnancy isn’t desired. The American College of Obstetricians and Gynecologists recommends a minimally invasive approach whenever feasible, meaning laparoscopic or vaginal hysterectomy rather than open surgery. Recovery times mirror those of myomectomy: a few weeks for minimally invasive procedures, longer for open surgery.
Newer Alternatives: Radiofrequency Ablation
Not all fibroid procedures involve cutting tissue out. Laparoscopic radiofrequency ablation (Lap-RFA) uses heat delivered through a needle-like probe to shrink fibroids in place. A meta-analysis of randomized trials found that quality-of-life improvements were essentially the same between Lap-RFA and laparoscopic myomectomy. The ablation approach had a meaningful advantage in blood loss, with patients losing roughly 44 milliliters less on average, and a shorter post-procedure hospital stay. Because fibroids are shrunk rather than removed, Lap-RFA can treat more fibroids in a single session. It’s a good option for people who want symptom relief without the tissue removal and scarring that come with traditional surgery.
Risks and Complications
Myomectomy has a low overall complication rate, but several risks are worth understanding before you go in.
- Blood loss. Fibroids have a rich blood supply, and bleeding during surgery is the most common concern. If you’re already anemic from heavy periods, your surgical team may work to build up your blood counts beforehand. Blood transfusions are sometimes needed.
- Scar tissue. Any incision on the uterus can lead to adhesions, bands of scar tissue that form as the body heals. These adhesions can sometimes affect fertility or complicate future surgeries.
- Pregnancy complications. A uterus that has been surgically repaired carries a small risk of rupture during labor, particularly if the muscle wall was cut deeply. Many women who’ve had myomectomies are advised to deliver by cesarean section.
- Unexpected hysterectomy. In rare cases, uncontrollable bleeding or unexpected findings during surgery may require the surgeon to remove the uterus.
- Tissue morcellation concerns. When fibroids are removed through small incisions, they sometimes need to be cut into pieces (morcellated) to fit through. In rare cases, a growth assumed to be a benign fibroid turns out to be cancerous, and morcellation can spread those cells. The FDA recommends that power morcellation only be performed with a tissue containment system to reduce this risk. Imaging findings suspicious for malignancy should rule out morcellation entirely.
Impact on Fertility
If preserving fertility is your priority, myomectomy is designed to give you that option. A key finding from Mayo Clinic research is that the probability of becoming pregnant and having a live birth is similar regardless of which type of myomectomy you have. Whether fibroids are removed through the abdomen, laparoscopically, or hysteroscopically, pregnancy rates don’t differ significantly. Over a three-year follow-up period studying more than 200 pregnancies, the surgical approach made no meaningful difference in outcomes for women intending to conceive.
That said, myomectomy involves a balance. Surgery can normalize the shape of the uterus and improve conditions for pregnancy, but it also creates scar tissue that could theoretically work against implantation. Hysteroscopic surgery tends to produce less scar tissue than approaches that cut through the uterine muscle wall. Your surgeon can help weigh whether the fibroids themselves or the surgery to remove them poses a greater risk to your fertility.
Fibroid Recurrence After Surgery
One of the most important things to know about myomectomy is that fibroids can grow back. The cumulative risk of recurrence is about 5% at two years and roughly 21% at five years. Some studies have reported five-year recurrence rates as high as 53%, depending on the surgical approach and patient population. This doesn’t mean you’ll necessarily need another surgery. Many recurrent fibroids are small and asymptomatic. But it does mean that myomectomy is not always a one-time fix, particularly for younger patients who are further from menopause, when fibroids naturally stop growing.
What Recovery Looks Like
Your recovery timeline depends almost entirely on which procedure you have. After a hysteroscopic myomectomy, you may feel well enough to resume normal activities within a day or two. Laparoscopic and robotic procedures typically need two to three weeks before you’re back to your routine, with restrictions on heavy lifting during that window. Open abdominal surgery requires the longest recovery at four to six weeks, similar to recovering from a cesarean section.
During the first week after any procedure that involves abdominal incisions, expect some soreness, fatigue, and light vaginal bleeding or discharge. Most surgeons recommend avoiding strenuous exercise and sexual activity for several weeks. If your job involves physical labor, plan for the full recovery window. Desk work can often resume sooner, particularly after minimally invasive procedures.