Myomectomy — Fibroid Removal Surgery Preserving the Uterus

Medically reviewed by Dr. Shweta Agarwal, MBBS, DGO. Last updated: June 2026.

Information on this page is educational and does not replace a medical consultation. Outcomes depend on individual clinical factors.

Aansh Hospital & IVF Center is a growing fertility clinic group serving Vidarbha and northern Telangana, with in-house diagnostic and surgical capability — including hysteroscopy and laparoscopy — available on-site. The full clinical picture of uterine fibroids — types, symptoms, and how they affect fertility — is covered on the uterine fibroids conditions page. This page focuses on the operation itself.

What is myomectomy, and how does it differ from hysterectomy?

Myomectomy removes the fibroids and repairs the uterine wall, leaving the uterus in place. Hysterectomy removes the uterus entirely and is therefore definitive: fibroids cannot recur, but pregnancy is no longer possible. For women who want to preserve their ability to conceive — or who simply want to keep their uterus — myomectomy is the surgical approach of choice. The fibroid is excised from the surrounding uterine muscle (myometrium) and the uterine wall is sutured closed; how many layers of suturing are required depends on how deeply the fibroid was embedded.

Because fibroids are hormonally driven by oestrogen, new fibroids can develop after myomectomy over time — this is fibroid recurrence rather than regrowth of the same fibroid. Recurrence is discussed in the risks section below.

When is myomectomy recommended? (Indications)

Myomectomy is considered when fibroids are causing significant symptoms or when fibroid location is believed to be affecting fertility or implantation. The full explanation of fibroid types and their fertility impact is on the uterine fibroids conditions page; the key clinical reasons for proceeding to surgery are:

• Heavy or prolonged menstrual bleeding causing anaemia, fatigue, or significant quality-of-life impact
• Pelvic pain, pressure, or bulk symptoms — urinary frequency, bowel pressure — from large fibroids
• Submucosal fibroids (projecting into the uterine cavity) affecting implantation or causing recurrent pregnancy loss
• Intramural fibroids that are significantly distorting the cavity (per ASRM 2017) or compressing a fallopian tube opening, or large non-distorting intramural fibroids (typically > 4 cm, per ASRM 2017)
• Pre-IVF cavity optimisation — removing a submucosal or cavity-distorting fibroid before IVF embryo transfer to improve the uterine environment
• Women who have been advised hysterectomy but wish to retain their uterus and are suitable for a fibroid-removing alternative

Myomectomy is not recommended for small, asymptomatic fibroids that do not distort the uterine cavity. The decision to operate is always made individually after reviewing symptoms, fibroid characteristics, imaging, and reproductive goals. A fertility assessment with Dr. Shweta Agarwal is the appropriate starting point.

How is the surgical approach chosen — hysteroscopic, laparoscopic, or open?

The single most important factor in choosing the surgical route is fibroid location relative to the uterine wall. Size, number, and the depth of muscle involvement also influence the decision:

These are not ranked by preference: the appropriate approach is the one that is safest and most complete for your individual fibroid anatomy. Dr. Shweta Agarwal will discuss the recommended route with you before surgery. A laparoscopic procedure may occasionally be converted to open if intraoperative findings warrant it — this is a clinical safety decision, not a complication.

What does hysteroscopic myomectomy involve?

Hysteroscopic myomectomy is used for submucosal fibroids — those projecting into the uterine cavity. It is performed via hysteroscopy: a thin telescope (hysteroscope) is passed through the cervix without any abdominal incision. A specialised instrument called a resectoscope or a morcellator is then used to shave or cut the fibroid down under direct vision until the cavity is restored to a normal shape.

Key points for patients:

• No incision on the abdomen or skin
• Performed under general or regional anaesthesia
• Usually a day-case procedure — you go home the same day in most cases
• Recovery: most patients return to normal activity within 3–5 days
• Because no uterine muscle (myometrium) incision is made, the uterine wall integrity is preserved — conception timing restrictions are shorter than for laparoscopic or open myomectomy

For submucosal fibroids with a large intramural component (Type 2 with deep extension), a staged procedure or laparoscopic approach may be recommended.

What does laparoscopic myomectomy involve?

Laparoscopic myomectomy is used for intramural fibroids (embedded in the uterine muscle wall) and subserosal fibroids (on the outer surface of the uterus). It is performed through 3–4 small (approximately 5–10 mm) incisions in the abdomen, using a camera (laparoscope — see laparoscopy) and specialised instruments.

Step by step:

1. General anaesthesia
2. Camera inserted through the navel; 2–3 additional small instrument ports
3. Fibroid identified; the overlying uterine muscle incised and the fibroid dissected out
4. The uterine wall closed in multiple layers of sutures — the quality of this repair matters for future pregnancy
5. The fibroid is removed from the abdomen using a contained technique
6. Port sites closed

Key points for patients:

• Admission: typically 1–3 nights depending on the extent of surgery
• Recovery: light desk activity within 1–2 weeks; full recovery approximately 3–4 weeks
• Because the uterine muscle is incised and repaired, a healing interval before attempting conception is advised — see the section on fertility after myomectomy below

What does open (abdominal) myomectomy involve?

Open myomectomy — also called abdominal myomectomy or laparotomy — involves a horizontal incision (bikini-line) across the lower abdomen. It is chosen when fibroids are very large, numerous, or anatomically positioned in a way that makes laparoscopic access less safe or less complete. The fibroid(s) are excised under direct vision and the uterine wall repaired with multiple suture layers.

Key points for patients:

• General anaesthesia; admission typically 2–4 days
• Recovery: 4–6 weeks before return to normal activity
• The scar is low on the abdomen and typically well-hidden by underwear or clothing
• Because the uterine repair is most extensive with open myomectomy, the recommended healing interval before conception is the longest of the three approaches

Open myomectomy is not chosen by default or as an inferior option — it is the appropriate route when it offers the safest and most thorough surgical result.

What happens before, during, and after myomectomy?

Before surgery (pre-operative preparation)

• Blood tests and a full blood count (to assess for anaemia from heavy bleeding)
• Iron therapy if anaemia is present — often started several weeks before the date of surgery
• Pre-operative ultrasound and/or MRI to map fibroid number, size, and position
• Anaesthesia assessment; fasting from midnight before the procedure
• Discussion with Dr. Shweta Agarwal about the planned surgical route, expected uterine repair, and post-operative recovery
• In some cases, a short course of GnRH analogue medication may be prescribed before surgery to temporarily reduce fibroid size and blood supply, which can reduce intraoperative blood loss

During surgery

All three approaches use general anaesthesia. Duration varies with fibroid burden and surgical complexity: hysteroscopic myomectomy is generally the quickest, followed by laparoscopic, with open myomectomy taking the longest.

After surgery (recovery)

• Pain is managed with standard post-operative analgesia; discomfort is generally well controlled
• Some vaginal bleeding or discharge for a few days after hysteroscopic myomectomy is normal
• Abdominal wound care for laparoscopic or open myomectomy; small dressings over port or incision sites
• A follow-up appointment is arranged to review the operative findings, histology report on the removed fibroid(s), and to confirm the uterus has healed before any plan for conception is made

When can I try to conceive after myomectomy?

A healing interval is commonly advised after laparoscopic or open myomectomy before attempting conception or starting an IVF cycle — this allows the uterine repair (the sutured myometrial wound) to consolidate and reduces the risk of complications in early pregnancy. The appropriate interval depends on the depth and extent of the uterine repair:

• Hysteroscopic myomectomy: Because no uterine muscle incision is made, conception may generally be attempted from the next menstrual cycle after a confirmatory follow-up check — though the exact timing depends on operative findings.
• Laparoscopic myomectomy: A healing interval of approximately 3–6 months is commonly advised to ensure adequate uterine scar recovery (per ASRM/RCOG).
• Open myomectomy: For more extensive repairs, an interval of approximately 3–6 months (or up to 6 months) is commonly recommended before conception or IVF to allow complete healing of the myometrium (per ASRM/RCOG).

These timelines are general clinical guidance; Dr. Shweta Agarwal will give you a specific recommendation based on the operative report and the extent of your uterine repair.

Mode of delivery: After significant laparoscopic or open myomectomy — particularly when the cavity was entered or a deep repair was made — a planned caesarean section is often recommended for delivery in a subsequent pregnancy, to avoid the risk of uterine rupture during labour at the repair site. This is discussed as part of your pre-operative counselling and again during any subsequent obstetric care.

Myomectomy and IVF — what is the connection?

Submucosal fibroids that project into the uterine cavity are associated with impaired embryo implantation and increased early pregnancy loss. For this reason, when a submucosal or cavity-distorting fibroid is identified during the work-up for IVF, it is generally removed — usually by hysteroscopic myomectomy — before the embryo transfer cycle begins. The sequence is: fibroid removal first, uterine healing confirmed, then IVF.

For intramural fibroids that do not distort the cavity, the decision to remove before IVF is made individually, weighing fibroid size, degree of any cavity proximity, the patient's age, and the surgical risk of removal. Not every fibroid requires removal before IVF — the assessment is key.

If you have been told you have fibroids and are considering IVF, a fertility assessment with Dr. Shweta Agarwal will clarify whether myomectomy is needed before your cycle, and if so, which approach and the likely timeline before IVF can proceed.

What are the risks of myomectomy?

Myomectomy is a planned, well-established surgical procedure, but carries real risks that are discussed with you before you consent to surgery:

• Blood loss — more than with routine laparoscopy, particularly for large or multiple intramural fibroids; rarely, a blood transfusion may be needed
• Conversion from laparoscopic to open — if intraoperative findings (fibroid size, adhesions, excessive bleeding) make laparoscopic completion unsafe; this is always a patient-safety decision
• Adhesion formation — post-surgical scarring (adhesions) inside the pelvis or around the tubes can occasionally form after myomectomy, with potential implications for future natural conception; laparoscopy is generally less likely to cause adhesions than open surgery
• Infection — a rare complication managed with post-operative antibiotics
• Fibroid recurrence — because myomectomy removes individual fibroids but does not alter the hormonal environment, new fibroids can grow over time; recurrence is more likely in women who had multiple fibroids than those with a single large fibroid
• Uterine rupture in a subsequent pregnancy — a rare but serious risk specifically related to the depth of myometrial repair, which is why conception timing and mode of delivery are discussed carefully; managed with planned caesarean in appropriate cases

Dr. Shweta Agarwal will review your specific fibroid anatomy, the planned surgical approach, and your individual risk profile before surgery, so you have a clear and honest picture of the benefits and risks for your situation.

What does myomectomy cost, and is EMI available?

See /costs-emi for current pricing information. Final cost depends on individual clinical evaluation.

The cost of myomectomy at Aansh Hospital & IVF Center depends on the surgical approach (hysteroscopic, laparoscopic, or open), the number and size of fibroids, anaesthesia, and any pre-operative work-up or post-operative stay. You receive a transparent written cost estimate before any procedure is booked.

• 0% EMI financing options are available (3–24 months)
• See IVF cost & 0% EMI for indicative cost ranges and EMI options; final cost depends on individual clinical evaluation