Myomectomy Specialist and Fibroids: What to Know

Uterine fibroids (leiomyomas) are common, noncancerous growths in the uterus that can cause heavy menstrual bleeding, pelvic pressure, pain, and fertility problems. If you hope to preserve your uterus or plan for pregnancy, a myomectomy—surgical removal of fibroids while keeping the uterus—may be the right option. Choosing an experienced myomectomy specialist can make a meaningful difference in outcomes, recovery, and future fertility.

Fibroids 101: Symptoms, Risks, and Who Is Affected

By age 50, up to 70–80% of women will develop fibroids, and many will experience symptoms. Black women are more likely to develop fibroids, at younger ages, with larger and more numerous growths. Common symptoms include:

• Heavy or prolonged menstrual bleeding (often with clots)
• Pelvic pain or pressure; low back or leg pain
• Frequent urination or constipation due to pressure on nearby organs
• Pain with intercourse
• Difficulty conceiving or pregnancy complications if fibroids distort the uterine cavity

Learn more from the National Institutes of Health and the U.S. Office on Women’s Health: NICHD: Uterine Fibroids and OWH: Uterine Fibroids.

When Does a Myomectomy Make Sense?

A myomectomy is typically recommended when you:

• Want to preserve fertility or your uterus
• Have significant symptoms (heavy bleeding, anemia, pain, pressure)
• Have fibroids that distort the uterine cavity, contributing to infertility or miscarriage
• Prefer a uterus-sparing procedure over hysterectomy

In contrast, hysterectomy (removal of the uterus) is definitive and eliminates fibroids but is not right for those who wish to maintain fertility. A thorough evaluation with a specialist will clarify your best options based on symptoms, reproductive goals, fibroid size, number, and location.

Types of Myomectomy: How They Differ

Myomectomy can be performed in several ways. The approach depends on the size, number, and location of fibroids, as well as your surgical history and overall health.

Hysteroscopic Myomectomy

Best for submucosal fibroids that protrude into the uterine cavity. A camera and instruments are inserted through the cervix (no abdominal incisions). Typical recovery is fast (days). It can markedly improve heavy bleeding and fertility when fibroids distort the cavity.

Laparoscopic or Robotic Myomectomy

Minimally invasive approach using small abdominal incisions, a camera, and specialized instruments. Benefits include less pain, reduced scarring and adhesions, and faster recovery (about 2–4 weeks) compared with open surgery. For larger fibroids, removal may require tissue morcellation. The U.S. Food and Drug Administration (FDA) advises that if laparoscopic power morcellation is considered, it should be performed only within a legally marketed tissue containment system in carefully selected patients due to the rare risk of spreading unsuspected uterine cancer. Discuss with your surgeon how they plan to remove fibroids and whether a contained system will be used. See the FDA safety communication: FDA: Laparoscopic Power Morcellation.

Open Abdominal (Laparotomy) Myomectomy

Best for very large or numerous fibroids, or when minimally invasive surgery is not feasible. Involves a larger incision and longer recovery (about 4–6 weeks). It allows en bloc removal without morcellation.

Alternatives to Myomectomy

Not everyone needs surgery. Depending on symptoms and goals, alternatives include:

• Watchful waiting for small, asymptomatic fibroids
• Medications for bleeding and pain: NSAIDs; hormonal contraceptives; the nonhormonal option tranexamic acid for heavy menstrual bleeding
• GnRH-based therapies that reduce menstrual bleeding from fibroids: elagolix with add-back (Oriahnn) and relugolix with add-back (Myfembree) are FDA-approved to manage heavy menstrual bleeding associated with fibroids in premenopausal women; they are typically time-limited because of potential effects on bone density (FDA on Oriahnn, FDA on Myfembree)
• Uterine Fibroid Embolization (UFE): a minimally invasive radiology procedure that shrinks fibroids by blocking their blood supply; typically not recommended for those actively pursuing pregnancy
• MR-guided focused ultrasound (MRgFUS): noninvasive thermal ablation available at select centers
• Hysterectomy: definitive treatment when childbearing is complete

Your specialist will help weigh trade-offs among efficacy, recovery time, fertility impact, and long-term outcomes.

How a Myomectomy Specialist Adds Value

A myomectomy specialist—often a gynecologic surgeon with advanced training in minimally invasive techniques—can optimize outcomes by:

• Recommending the right surgical approach based on detailed imaging (transvaginal ultrasound, saline infusion sonogram, or pelvic MRI for complex cases)
• Maximizing uterine preservation while fully removing cavity-distorting fibroids
• Minimizing bleeding through careful surgical planning; some patients benefit from preoperative iron supplementation or short-term hormone therapy
• Reducing adhesions and complications through meticulous technique
• Coordinating fertility care and pregnancy planning post-surgery

What to Expect: Before, During, and After Surgery

Before Surgery

• Evaluation: history, exam, imaging to map fibroids and assess the uterine cavity
• Optimizing health: treating anemia (oral or IV iron), managing blood pressure or diabetes, and reviewing all medications
• Shared decision-making: reviewing risks, benefits, alternatives, recovery time, and pregnancy plans

The Procedure

Myomectomy is performed under anesthesia. Duration varies with fibroid number and size. Your surgeon will close uterine incisions in multiple layers to support healing and future pregnancies.

Recovery

• Hysteroscopic: back to routine activities in a few days
• Laparoscopic/robotic: most return to desk work in 1–2 weeks; full activity by 3–4 weeks
• Open: expect 4–6 weeks for full recovery

Pain is usually manageable with a stepwise regimen; early ambulation, hydration, and gentle activity help recovery. Your specialist will provide instructions on wound care, activity restrictions, when to resume intercourse, and follow-up.

Risks, Recurrence, and Future Fertility

All surgeries carry risks, including bleeding, infection, injury to nearby organs, scar tissue (adhesions), and need for conversion to open surgery. There is a small risk of uterine rupture in pregnancy after myomectomy; the likelihood depends on the size and depth of uterine incisions. Many obstetricians recommend cesarean delivery after deeper or multiple uterine incisions—your surgeon and obstetrician will individualize guidance.

Fibroids can recur because the uterus can develop new fibroids over time. Recurrence rates vary by age and number of fibroids but can require additional treatment for a subset of patients within several years. Pregnancy is often possible after myomectomy, especially when cavity-distorting fibroids are removed; your specialist may recommend waiting 3–6 months before trying to conceive.

How to Choose the Right Myomectomy Specialist

• Experience and volume: Ask how many myomectomies they perform annually and their minimally invasive success rates
• Range of techniques: Ensure they offer hysteroscopic, laparoscopic/robotic, and open approaches—and can explain why one is best for you
• Safety practices: Discuss blood loss minimization, adhesion prevention, and morcellation strategy consistent with FDA guidance
• Fertility focus: Clarify how your plan aligns with fertility goals and pregnancy safety
• Hospital resources: Availability of advanced imaging, anesthesia protocols, and enhanced recovery pathways

Key Takeaways

• Fibroids are common and often treatable; a myomectomy can relieve symptoms while preserving fertility.
• The best approach depends on your symptoms, fibroid characteristics, and reproductive plans.
• An experienced specialist helps you navigate choices, optimize safety, and plan for future pregnancy.

Trusted Sources

• NIH/NICHD: Uterine Fibroids
• U.S. Office on Women’s Health: Uterine Fibroids
• ACOG: Uterine Fibroids FAQ
• FDA: Safety Communication on Laparoscopic Power Morcellation
• FDA: Oriahnn approval and Myfembree approval

This article is for general education and does not replace personalized medical advice. Consult a qualified gynecologist to determine the safest and most effective plan for you.