Myomectomy

Overview

Myomectomy is surgery to remove uterine fibroids (also called myomas or leiomyomas) — non-cancerous growths of muscle and fibrous tissue in the wall of the uterus — while keeping the uterus itself intact. Because it preserves the womb, myomectomy is the main fibroid operation for women who wish to retain their fertility or simply prefer not to have their uterus removed.

Fibroids vary greatly in size, number and location. Some sit just under the lining and bulge into the cavity, some grow within the muscular wall, and others project outward. These positions determine how the fibroids are best removed — through the vagina, through keyhole incisions, or through an open abdominal incision.

Myomectomy can reliably remove the fibroids present at the time of surgery, but it does not prevent new fibroids from forming. This page is an educational overview only. It is not medical advice, and no outcome, including future pregnancy, can be guaranteed.

Who May Need This

Myomectomy may be considered for women with fibroids that cause troublesome symptoms and who want to keep their uterus. Typical symptoms include heavy or prolonged menstrual bleeding, sometimes leading to anaemia, pelvic pressure or pain, frequent urination from pressure on the bladder, and, in some cases, difficulty conceiving or recurrent pregnancy loss linked to fibroids distorting the cavity.

It is particularly relevant for women planning a future pregnancy. Whether myomectomy is appropriate — and which approach is safest — can only be determined by a gynaecologist after imaging, because the decision depends on the size, number and position of the fibroids and your reproductive goals.

When It May Be Recommended

A specialist may recommend myomectomy when fibroid symptoms significantly affect daily life or fertility and medication has not provided enough relief, or when a fibroid is distorting the uterine cavity in a woman trying to conceive. It is generally preferred over hysterectomy when preserving the uterus is important.

The decision weighs the benefit of symptom relief and possible fertility improvement against the risks of surgery and the chance that new fibroids may develop later. Because uterus-sparing alternatives such as medication or uterine artery embolisation exist, a full discussion of options is worthwhile before proceeding.

Diagnosis and Evaluation

Evaluation usually includes a pelvic examination and a pelvic ultrasound to confirm the fibroids and assess their size and position. An MRI may be used to map multiple fibroids precisely before surgery, and a hysteroscopy or saline ultrasound can show fibroids bulging into the cavity. Blood tests often check for anaemia from heavy bleeding.

Because fibroids and their symptoms can overlap with other conditions, your doctor may also assess for adenomyosis or, rarely, other growths. A clear map of the fibroids guides the choice of surgical approach and helps set realistic expectations about symptom relief and fertility.

Treatment Options

Myomectomy is performed by one of three main routes, selected according to the fibroids. Hysteroscopic myomectomy removes fibroids that bulge into the cavity using a thin telescope passed through the vagina and cervix, with no external incision. Laparoscopic or robot-assisted myomectomy uses several small abdominal incisions and a camera to remove fibroids in the wall or on the surface of the uterus.

Open (abdominal) myomectomy uses a single larger incision and is often chosen for very large, numerous, or deeply embedded fibroids. The surgeon removes each fibroid and carefully repairs the uterine wall, which is important for strength in a future pregnancy. The best route balances thorough fibroid removal against recovery time and the security of the uterine repair.

How It Is Performed

Myomectomy is usually performed under general anaesthesia. In a hysteroscopic procedure, fluid distends the uterine cavity and the surgeon shaves or removes the fibroid from within. In laparoscopic or robotic surgery, the fibroids are cut from the uterine muscle, removed through the incisions, and the wall is stitched in layers.

Open myomectomy follows similar principles through a larger incision, allowing the surgeon to feel and repair the uterus directly for large fibroids. Techniques to limit blood loss may be used, and operating time varies with the number and size of fibroids. Careful repair of the uterine wall is a key part of the operation for women planning pregnancy.

Preparation

Preparation may include treating anaemia beforehand, and in some cases short-term medication to shrink large fibroids and reduce bleeding at surgery. You will complete pre-operative tests, review and adjust medications such as blood thinners, and follow fasting instructions. Your team may discuss measures to reduce blood clot risk.

If you are travelling for surgery, plan for the recommended in-country stay and early recovery, arrange help at home, and bring copies of your ultrasound or MRI images and records. If future pregnancy is a goal, discuss timing and any advice about delivery in advance.

Benefits and Expected Goals

The goals of myomectomy are to relieve fibroid symptoms — particularly heavy bleeding and pelvic pressure — while preserving the uterus. For women with fibroids distorting the cavity, removal may improve the chance of conceiving or carrying a pregnancy, though this cannot be guaranteed.

Benefits vary with the number, size and position of fibroids and with your individual situation. Because myomectomy does not prevent new fibroids, some women experience symptoms again in later years. Your surgeon can discuss realistic goals and the likelihood of lasting relief in your case.

Risks and Possible Complications

Myomectomy carries the general risks of surgery and some specific to fibroid removal. Because the uterus has a rich blood supply, bleeding can be significant, occasionally requiring a transfusion. Other risks include infection, injury to nearby organs, and scar tissue (adhesions) forming inside the pelvis.

• Heavier-than-expected bleeding, rarely needing a transfusion
• Infection or delayed wound healing
• Adhesions that may affect fertility or cause pain
• Weakening of the uterine wall, which may influence future delivery
• Rarely, conversion to a larger incision or the need to remove the uterus if bleeding cannot be controlled
• Recurrence of fibroids over time

Your surgeon will explain the risks specific to your fibroids and health, and how they will be reduced. Report any concerning symptoms promptly after surgery.

Recovery, Follow-up & Aftercare

Recovery depends on the approach. After hysteroscopic myomectomy, many women return to normal activities within a few days. Laparoscopic or robotic surgery typically needs about 2 to 4 weeks, and open abdominal myomectomy around 4 to 6 weeks before strenuous activity or heavy lifting. Some light bleeding or cramping afterwards is common.

If you plan to conceive, your surgeon may advise waiting several months to allow the uterus to heal, and may recommend a caesarean delivery depending on how deep the fibroids were. Arrange follow-up with your local doctor, confirm when it is safe to fly if you have travelled, and keep any recommended appointments to monitor for new fibroids.

Medical Tourism Planning

If you are considering myomectomy abroad, choose a JCI- or ISO-accredited hospital with an established gynaecology or reproductive surgery programme. Verify the surgeon experience with your planned approach — especially laparoscopic or robotic uterine repair — and request a written treatment plan and cost estimate before you travel.

Plan for the in-country stay your team recommends, confirm medications and wound care, and arrange follow-up at home. Because pelvic surgery carries a clot risk, ask when it is safe to fly. If fertility is your goal, discuss timing of future pregnancy before travelling. Consider medical travel insurance.

Estimated Cost Factors

The cost of myomectomy depends on the country and hospital, the surgical route (hysteroscopic, laparoscopic, robotic or open), the number and size of fibroids, operating time, length of stay, anaesthesia, and any imaging or pre-treatment medication. Robotic surgery is generally more costly than conventional laparoscopy.

Many international destinations offer this surgery at a fraction of typical US prices, but figures vary widely by case. Prices quoted online are only estimates — always request a personalized written quote for your specific situation before making any decision.

Choosing a Hospital or Specialist

Look for a hospital with recognised accreditation and a gynaecology department experienced in fibroid surgery. Confirm the surgeon board certification and specific experience with your planned approach, and, if fertility matters, their experience with fertility-preserving myomectomy and careful uterine repair.

Ask about international patient services, interpreter support, blood bank availability for larger cases, and how follow-up and complications would be handled after you return home. Transparent written cost and treatment plans are good signs of a quality programme.

Alternatives

Depending on your symptoms and goals, alternatives may include medication (hormonal treatments or a hormonal IUD to control bleeding), uterine artery embolisation to shrink fibroids by cutting their blood supply, MRI-guided focused ultrasound where available, or hysterectomy if fertility is not a concern and definitive treatment is preferred.

Each option has different effects on symptoms, fertility, and recovery. Embolisation and some other treatments may not be recommended for women wishing to conceive. Discuss all options with your healthcare provider so the plan fits your fibroids, symptoms, and reproductive goals.

Questions to Ask Your Doctor

• Is myomectomy the best option for my fibroids, or would embolisation or hysterectomy suit me better?
• Which surgical route do you recommend, and why?
• How might this surgery affect my fertility and any future delivery?
• What is the chance my fibroids will come back?
• What are the specific risks in my case, and how will bleeding be managed?
• How long should I stay in-country, and when can I safely fly home?
• What is included in the written cost estimate?