Which approach will I need?

It depends mainly on where the fibroid sits — inside the cavity, within the wall, or on the outer surface — and on its size. A scan and examination will tell us which of the three approaches applies.

Does myomectomy remove all fibroids at once?

All fibroids identified before surgery are removed in the same operation where possible; very small ones not visible on scan can occasionally be found later.

Can fibroids come back after myomectomy?

New fibroids can form over time since the underlying tendency to form them is not removed along with the fibroid itself.

Is hysteroscopic myomectomy a day procedure?

Often, yes — since no abdominal cut is involved.

Myomectomy: removing fibroids, keeping the uterus

Myomectomy removes fibroids while leaving the uterus in place. It is the usual choice when fibroids are causing symptoms that need treating and the uterus itself is being kept — whether because pregnancy is still wanted, or simply because there is no reason to remove an organ that does not need removing.

The three approaches

Laparoscopic myomectomy

For fibroids on or within the outer muscle wall, removed through two or three small abdominal cuts using keyhole instruments.

Hysteroscopic myomectomy

For fibroids bulging into the uterine cavity. A telescope is passed through the cervix with no cut anywhere, and the fibroid is shaved away from inside the cavity — often as a single, short, day-care visit.

Open myomectomy

Kept for fibroids that are very large, very numerous, or otherwise unsuitable for a keyhole approach.

Choosing between myomectomy and hysterectomy

Myomectomy is chosen when the fibroids, not the uterus itself, are the problem, and there is a reason to keep the uterus — most commonly because pregnancy is still wanted. See fibroids for the fuller treatment ladder, and the hysterectomy overview for when removing the uterus itself is the right step instead.

Recovery

Recovery follows the approach used. Hysteroscopic myomectomy has the shortest recovery, often a day or two before normal activity. Laparoscopic myomectomy usually means a one- or two-night stay and two to four weeks before full activity. Open myomectomy needs the longest recovery, similar to open hysterectomy. A degree of period-like cramping and light bleeding for a few days after any of the three is normal.

Fibroids, myomectomy and fertility

Because myomectomy preserves the uterus, it is the approach usually discussed when fibroids come up during a fertility work-up. Whether a particular fibroid is affecting fertility, and whether removing it is likely to help, depends on its size and exactly where it sits — an assessment made on your own scans, not a general rule.

Who operates

Dr. Mayur Pai (MBBS, MS Obstetrics & Gynaecology), a laparoscopic surgeon of 15 years, carries out the operation himself, by whichever of the three approaches suits your fibroids.

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This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.