Myomectomy: Removing Fibroids While Preserving the Uterus
A myomectomy is a surgical option for removing uterine fibroids when there is a strong desire to preserve the uterus — whether for fertility, personal identity, or other individual reasons. Instead of removing the uterus itself, the procedure focuses on removing the individual fibroids and leaving the uterus in place.
This article walks through what a myomectomy actually is, when it makes sense, the different ways it can be done, and what recovery and outcomes realistically look like.
What Is a Myomectomy?
A myomectomy is surgery to remove uterine fibroids (also called leiomyomas) while preserving the uterus. The fibroids are removed from the uterine muscle, and the uterus is repaired afterward.
Fibroids are benign growths that arise from the muscle of the uterus. They can be located:
- Inside the uterine cavity
- Within the uterine wall
- On the outer surface of the uterus
- Or in combinations of all three
The number, size, and location of fibroids largely determines which type of myomectomy is recommended.
(You can read more about fibroids in our linked article!)
Who Is a Good Candidate?
Having fibroids alone does not automatically mean you need surgery. Fibroids are extremely common, and many people live with them without symptoms or complications.
A myomectomy may be considered if you:
- Have heavy or prolonged bleeding related to fibroids
- Have pelvic pain, pressure, or bulk symptoms
- Want to preserve fertility or the uterus
- Are not ready for, or do not want, a hysterectomy
If fibroids are not causing heavy bleeding, significant pain, pressure symptoms, or problems with pregnancy, they can often be monitored rather than treated. Decisions about whether fibroids need intervention depend on symptoms, goals, and how much they are impacting quality of life. Talking with your provider can help determine whether treatment is needed - and if so, when.
Types of Myomectomy
Hysteroscopic Myomectomy
This approach is used only for submucosal fibroids, meaning fibroids that are located inside the uterine cavity. A camera and surgical instruments are passed through the cervix — no abdominal incisions are made.
Not all fibroids that touch the cavity can be removed this way. Some are too large, or only a small portion of the fibroid protrudes into the cavity, making hysteroscopic removal unsafe or incomplete.
When it is an option, hysteroscopic myomectomy has several advantages. It is typically performed as an outpatient procedure, has a much shorter recovery time, and avoids both abdominal and uterine incisions.
Laparoscopic or Robotic Myomectomy
This is a minimally invasive surgical approach. Several small abdominal incisions are made, and long instruments (sometimes with robotic assistance) are used to remove fibroids from the uterus and then repair the uterine muscle.
This approach can be used for fibroids in many locations, including those within the uterine wall or on the outer surface. There are limitations, however. The size, number, and location of fibroids matter, and very large fibroids or numerous fibroids may not be safely removable with minimally invasive instruments.
Compared with open surgery, this approach is associated with less blood loss, faster recovery, and smaller scars. It requires advanced surgical skill, so not all gynecologists are able to offer this option.
Open (Abdominal) Myomectomy
An open myomectomy uses a larger incision to access the uterus directly and remove fibroids. The incision may be horizontal (similar to a C-section incision) or vertical, depending on the size of the uterus and complexity of the surgery.
This approach is typically used for very large fibroids, numerous fibroids, complex anatomy, or in patients with significant prior abdominal surgery.
Recovery is longer, postoperative pain is greater, and a short hospital stay is usually required. However, this is still an extremely common and safe approach when needed. While more invasive, it can preserve the uterus and may be the safest option in certain situations.
Preoperative Planning
Fibroids are often first suspected on pelvic exam and confirmed with pelvic ultrasound. Depending on the planned surgery, many surgeons will recommend a preoperative MRI.
MRI serves two important purposes. First, it provides more detailed imaging than ultrasound and can show the exact number, size, and location of fibroids — often referred to as fibroid mapping. This helps surgeons plan the procedure, including surgical approach and where the uterus may need to be opened.
Second, MRI is the best imaging tool we have for evaluating fibroids for unusual or suspicious features (including cancer) that may change treatment planning.
If your surgeon recommends an MRI before surgery, this is usually a green flag and part of careful preoperative planning.
Myomectomy vs. Other Options
Myomectomy is one option among many for treating symptomatic uterine fibroids.
Other options may include:
- Medication
- Hormonal suppression
- Uterine artery embolization
- Radiofrequency ablation — a minimally invasive approach using heat (e.g., Acessa or Sonata)
- High-intensity focused ultrasound (HIFU) — a non-invasive fibroid ablation using focused ultrasound guided by MRI
- Hysterectomy
The best option depends on symptoms, goals, anatomy, and values - and should be an individualized decision you make along with your trusted provider.
Fertility and Fibroids
The relationship between fibroids and fertility depends heavily on fibroid location, size, number, and individual factors.
Fibroids can affect fertility in some patients, particularly when they distort the uterine cavity or interfere with implantation. In those cases, removing fibroids may improve fertility outcomes. However, studies show that removing fibroids that do not distort the cavity — such as some intramural or subserosal fibroids — often does not improve pregnancy rates.
Many people with fibroids conceive without intervention. If you are concerned that fibroids may be impacting fertility, it’s important to discuss the specific type and location of your fibroids with your provider.
Pregnancy After Myomectomy
Pregnancy after myomectomy is possible for many patients, but planning matters.
For abdominal approaches — including laparoscopic, robotic, or open myomectomy — the uterus usually needs time to heal before pregnancy. Many providers recommend waiting at least six months before trying to conceive, though this can vary depending on how deeply the uterus was incised. This should be discussed with your surgeon ahead of time if future pregnancy is a goal.
In some cases, especially when the uterine muscle was cut deeply or extensively, a cesarean delivery may be recommended in future pregnancies to reduce the risk of uterine rupture. Uterine rupture is a rare but serious complication in which the uterus opens during pregnancy or labor. This recommendation is not meant as a punishment — it is done to keep both the pregnant person and baby safe.
In most scenarios, patients are typically allowed to reach full-term pregnancy. Planned delivery often occurs before labor begins, commonly between 37 and 39 weeks, depending on the incision. The most important step is discussing these expectations ahead of time so there are no surprises later.
Risks and Limitations
As with any surgery, myomectomy carries risks.
The biggest concern with myomectomy is bleeding, especially when fibroids are large or numerous. Bleeding can occasionally be significant, and blood transfusion is not uncommon even when careful surgical techniques are used to minimize blood loss. Very rarely - in well under 1% of cases - bleeding can be life-threatening, and a hysterectomy may be required to save a patient’s life.
Other risks include infection, injury to surrounding structures, and the need to convert to a larger incision if a minimally invasive approach is planned but cannot be safely completed.
Another important limitation is fibroid recurrence. Even when all visible fibroids are removed, new fibroids may develop over time. The more fibroids present initially, the higher the chance of recurrence. In some cases, not all fibroids can be safely removed during surgery, which may limit symptom improvement.
Additionally, some symptoms such as heavy bleeding or pelvic pain may persist, especially if they are caused by conditions other than fibroids.
Recovery: What to Expect
Recovery depends on the type of myomectomy performed:
- Hysteroscopic: days to about a week
- Laparoscopic or robotic: about 2–4 weeks
- Open: 4–6 weeks or longer
Because the uterus itself is operated on and repaired, recovery often includes abnormal bleeding and uterine cramping. These symptoms can last for days to weeks, and it may take time for menstrual cycles to regulate. This can be frustrating, but it is usually normal.
Other common recovery experiences include fatigue, bloating, constipation, and general soreness. Clear expectations and recovery planning should be part of the preoperative conversation.
The Bottom Line
Myomectomy can be an effective option for removing fibroids when preservation of the uterus is a priority. Choosing this surgery requires thoughtful discussion about goals, limitations, recovery, and the possibility of recurrence.
Finding a surgeon who listens to you, takes your concerns seriously, and explains your options clearly is essential. A good decision is one that fits your body, your goals, and your life.
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