Up to 80 percent of women develop uterine fibroids by age 50, though only a fraction cause symptoms severe enough to need treatment. A myomectomy removes fibroids from the uterus while leaving the uterus itself intact — a key distinction from hysterectomy and a major reason it is the preferred operation for patients who want to preserve fertility. Depending on the size, number, and location of the fibroids, the surgery can be done through small keyhole incisions, through the cervix without any external incision, or through a traditional open approach.
What a Myomectomy Is and Who Needs One
Fibroids, also called leiomyomas, are noncancerous growths of the uterine muscle. They can cause heavy menstrual bleeding, pelvic pressure, urinary frequency, painful intercourse, and in some cases infertility or pregnancy complications. A myomectomy is considered when fibroids are symptomatic and the patient wants to keep the uterus.
According to the American College of Obstetricians and Gynecologists (ACOG), indications for myomectomy include fibroids that distort the uterine cavity (often associated with infertility or recurrent miscarriage), fibroids causing heavy bleeding or anemia not controlled with medication, rapidly growing fibroids, and bulk symptoms from large fibroids pressing on the bladder or bowel.
How the Procedure Is Performed
The right approach depends on fibroid size, number, and location. Cleveland Clinic outlines the four main techniques.
Hysteroscopic myomectomy removes fibroids through the vagina and cervix using a slim camera and a resecting tool. It is reserved for fibroids that bulge into the uterine cavity (submucosal fibroids). No external incisions are needed and recovery is the fastest of any approach.
Laparoscopic and robotic myomectomy use small abdominal incisions and a camera. They are well suited to a moderate number of fibroids of small to medium size. Operating times typically run 2 to 4 hours.
Open (abdominal) myomectomy uses a 4- to 6-inch incision in the lower abdomen and is preferred for very large fibroids, multiple fibroids in difficult locations, or when fertility preservation requires meticulous reconstruction of the uterine wall.
General anesthesia is standard for all approaches. Hospital stays range from same-day discharge (hysteroscopic) to 1 to 3 nights (open).
Preparation and What to Expect on the Day
Pre-operative work-up usually includes pelvic imaging (MRI or ultrasound), blood counts to assess for anemia, and sometimes pretreatment with GnRH agonists or oral medications to shrink fibroids and improve hemoglobin before surgery. Iron supplementation is common for several months prior in heavy-bleeding patients.
You will be asked to fast after midnight, stop blood thinners on schedule, and arrive several hours before surgery. After the procedure, a urinary catheter is typically placed during the operation and removed within 24 hours. Pain is managed with a multimodal approach combining acetaminophen, NSAIDs, and short-course opioids when needed.
Recovery Timeline
Recovery varies dramatically by approach. According to the NIH MedlinePlus:
- Hysteroscopic: back to desk work in 1 to 2 days, full activity in 1 week
- Laparoscopic or robotic: back to desk work in 1 to 2 weeks, full activity in 4 weeks
- Open abdominal: back to desk work in 4 to 6 weeks, full activity in 6 to 8 weeks
Expect light vaginal bleeding and discharge for several weeks regardless of approach. Walking is encouraged immediately to reduce blood clot risk. Heavy lifting (over 10 to 15 pounds) is restricted for the duration of incisional healing.
When to seek emergency care: Call 911 or go to the nearest emergency room if you experience heavy vaginal bleeding soaking more than a pad per hour, fever above 101 degrees Fahrenheit, severe abdominal pain, calf pain or swelling, sudden shortness of breath, or signs of infection at the incision site.
Risks, Complications, and Outcomes
Myomectomy is overall safe but carries somewhat higher bleeding risk than hysterectomy because the surgeon must dissect through the uterine muscle. Reported transfusion rates run 2 to 10 percent depending on fibroid burden. Other risks include infection, injury to bladder, ureter, or bowel, blood clots, anesthesia complications, and adhesions.
A particular concern is recurrence. New fibroids can grow after surgery; up to 25 percent of patients develop new symptomatic fibroids within 5 years. About 10 to 15 percent eventually undergo a second procedure. For pregnancy after myomectomy, surgeons often recommend cesarean delivery if the uterine cavity was entered during surgery, due to the small risk of uterine rupture.
Alternatives and When Surgery May Not Be Needed
Not every fibroid requires surgery. Watchful waiting is appropriate for asymptomatic fibroids, especially near menopause when growth often slows. Hormonal IUDs and oral contraceptives manage bleeding without surgery in many cases. Uterine artery embolization (UAE), an interventional radiology procedure, blocks blood supply to fibroids and avoids surgery, though it is not generally recommended for women planning future pregnancies. MRI-guided focused ultrasound is a noninvasive option in select centers. A D&C may be performed alongside hysteroscopic myomectomy for diagnostic purposes when bleeding is the primary concern. For patients no longer desiring fertility and with severe symptoms, hysterectomy remains the only treatment with no risk of recurrence.
Cost Considerations
Without insurance, myomectomy costs typically range from $10,000 to $25,000 depending on approach. Hysteroscopic procedures sit at the lower end and open abdominal myomectomy at the higher end. With commercial insurance, out-of-pocket costs commonly fall between $1,500 and $5,000. Robotic procedures may not always be covered as the preferred approach over laparoscopic by all insurers. Our healthcare costs guide walks through how to estimate facility versus professional fees. For background on uterine and pelvic conditions more broadly, the medical conditions resource library covers diagnosis and management of related issues.
Frequently Asked Questions
Will I be able to get pregnant after a myomectomy?
Most patients can conceive after myomectomy, especially when the procedure was done specifically to address infertility or recurrent miscarriage. Pregnancy rates of 50 to 70 percent are reported in studies of women undergoing myomectomy for infertility. Your surgeon will advise on how long to wait before trying — usually 3 to 6 months — based on which uterine layers were entered.
How long does a myomectomy last before fibroids come back?
About 25 percent of patients develop new symptomatic fibroids within 5 years, and 10 to 15 percent eventually have a second procedure. Recurrence is more common in younger women, those with multiple fibroids removed, and those who do not become pregnant after surgery.
Can a myomectomy be done if I don’t want children?
Yes. Many women choose myomectomy over hysterectomy regardless of fertility goals if they prefer to keep the uterus. Hysterectomy is the only definitive cure but is a more extensive surgery, so the trade-off is individual.
Is laparoscopic myomectomy as effective as open surgery?
For appropriate candidates, yes. Studies have shown similar pregnancy rates and symptom relief between open and laparoscopic approaches when done by experienced surgeons. Surgeon experience matters more than the technology used.
What to Discuss With Your Doctor
Useful conversations before scheduling a myomectomy include which approach is best for your fibroid pattern, what the expected blood loss and transfusion risk is, whether you may need to convert from minimally invasive to open during surgery, how long to wait before pregnancy, and whether cesarean delivery will be recommended for any future deliveries. If recurrence is a concern, asking about adjuvant therapies and recurrence rates at your surgeon’s center can help inform the decision.