Fibroids are common, non-cancerous growths made of uterine muscle tissue. They can sit inside the uterine cavity, within the uterine wall, or on the outer surface—and that location is the reason treatment choices differ so much.  

A key point upfront: fibroid removal surgery is usually done for symptoms or specific goals, not because fibroids are automatically dangerous. Many people have fibroids and never need an operation.  

This guide explains when surgery is considered, what the main surgical types are, how the procedure typically goes, the real risks, and what recovery usually feels like. 

1) Fibroid symptoms that commonly lead to surgery 

Fibroids can cause symptoms by bleeding, pressure, or distortion of the uterine cavity. Typical fibroid symptoms include: 

• Heavy menstrual bleeding (sometimes leading to anemia) 

• Pelvic pressure or fullness, bloating-like discomfort 

• Pelvic pain or pain during sex 

• Frequent urination (pressure on the bladder) 

• Fertility or pregnancy issues in some cases (especially when fibroids distort the cavity)  

Surgery tends to enter the conversation when symptoms affect daily life, when anemia keeps recurring, when medications aren’t enough, or when the fibroid’s location is interfering with fertility plans. 

2) Fibroid removal options: where surgery fits in uterine fibroid treatment 

Not every treatment removes fibroids. Some treatments mainly reduce bleeding or shrink fibroids temporarily. ACOG outlines that options include medications and procedures, and the “right” choice depends on symptoms, size/location, and pregnancy plans.  

Fibroid removal surgery usually means one of two intentions: 

1. Remove the fibroid(s) and keep the uterus (myomectomy), or 

2. Remove the uterus (hysterectomy) if definitive treatment is needed and childbearing is not desired (this article focuses mainly on fibroid removal while preserving the uterus). 

3) Types of fibroid removal surgery 

The “best” surgery is the one that fits the fibroid’s location, size, and number, because those factors determine what is physically possible and what is safest. 

A) Hysteroscopic myomectomy (for fibroids inside the cavity) 

This is done through the vagina and cervix using a thin camera (hysteroscope). It’s typically used for submucosal fibroids—fibroids that bulge into the uterine cavity.  

• No abdominal cuts 

• Often day-care surgery 

• Commonly chosen when heavy bleeding is the main issue and the fibroid is accessible inside the cavity  

B) Laparoscopic (or robotic) myomectomy (keyhole surgery) 

Small abdominal incisions are used to remove fibroids and repair the uterine wall. This can suit certain intramural (within the wall) or subserosal (outer surface) fibroids depending on size/number and surgeon assessment.  

• Smaller incisions, typically less postoperative discomfort than open surgery 

• Often faster recovery than abdominal/open myomectomy (for many patients)  

C) Abdominal (open) myomectomy 

This is a larger incision on the abdomen to remove fibroids directly. It’s commonly used when fibroids are very large, numerous, or located in ways that make keyhole surgery difficult or unsafe.  

• Longer recovery compared with laparoscopic approaches 

• Sometimes the safest approach for complex fibroid patterns  

D) Hysterectomy (not fibroid “removal,” but definitive uterine fibroid treatment) 

A hysterectomy removes the uterus and is the only option that guarantees fibroids won’t return, but it ends fertility. It’s usually considered when symptoms are severe and the person does not want future pregnancy.  

4) Myomectomy surgery: what happens during the procedure 

A helpful way to picture a myomectomy is: the surgeon removes the fibroid(s) and then rebuilds the uterus so it heals strongly. 

Mayo Clinic describes myomectomy as surgery to remove fibroids while leaving the uterus in place (unlike hysterectomy).  

Typical steps (vary by approach) 

1. Anesthesia (often general anesthesia) 

2. Access (through the cervix for hysteroscopic; through small abdominal ports for laparoscopic; through an abdominal incision for open)  

3. Fibroid removal 

4. Uterine repair (especially important for intramural fibroids)  

5. Recovery room monitoring and discharge plan based on bleeding control, pain control, and stability 

A practical note: your surgeon may not be able to remove every tiny fibroid, and fibroids can recur over time—especially if menopause is far away.  

5) Benefits of fibroid removal surgery 

Symptom relief 

• Heavy bleeding often improves, therefore anemia risk can drop (when bleeding is the main symptom).  

• Pressure symptoms can improve when bulk is removed. 

Uterus preservation (for those who want it) 

Myomectomy is specifically used when the goal is to remove fibroids but keep the uterus, including for future pregnancy planning.  

6) Risks and possible complications 

Every surgical option has trade-offs. The main risks discussed in patient-facing medical resources include: 

Bleeding and transfusion risk 

Fibroids are vascular, therefore bleeding is one of the major intraoperative concerns—particularly in large or multiple fibroids.  

Infection and wound issues 

As with most surgeries, infection is possible (uterus, pelvis, incision sites).  

Injury to nearby organs 

Depending on fibroid size/location and adhesions, there can be risk to bladder, bowel, or ureters (risk varies by complexity).  

Scar tissue (adhesions) 

Adhesions can form after surgery and may contribute to pain or fertility issues in some cases (risk varies). 

Recurrence 

Myomectomy can be very effective, but fibroids can grow back, and some people may need further treatment later.  

Pregnancy considerations after myomectomy 

If the uterine wall was deeply repaired, future pregnancy and delivery planning may change. Johns Hopkins notes that after abdominal or laparoscopic myomectomy, there can be increased risk of uterine rupture in pregnancy/labor, and some people may be advised to have a C-section depending on surgical details.  
This is why the operative note matters—because the depth and location of uterine incisions influence recommendations. 

7) Recovery: what it usually looks like (by surgery type) 

Recovery depends on how the uterus was accessed and how much repair was needed. 

Hysteroscopic myomectomy recovery 

Often a same-day discharge with cramps/spotting for a short period is common. NHS describes hysteroscopic approaches for fibroids within the womb as day procedures in many cases.  

Laparoscopic myomectomy recovery 

Typically faster than open surgery for many patients, but you still need real rest because the uterus is healing internally. Cleveland Clinic notes recovery varies, and patients should follow their surgeon’s timeline for returning to activities.  

Abdominal (open) myomectomy recovery 

Generally longer recovery because of the larger incision and deeper tissue healing. NHS patient information leaflets for abdominal myomectomy emphasize that suitability depends on fibroid size/number/location and that it is a significant procedure.  

A useful way to think about recovery: 
Even if the skin cuts are small (laparoscopy), the uterus may have had multiple repairs. Therefore you may feel “fine outside” while still needing time inside. 

8) Questions worth asking before choosing a fibroid removal option 

These are practical questions that lead to clearer decisions: 

1. Where are my fibroids located (submucosal / intramural / subserosal)? 

2. Which approach fits that location and why? (hysteroscopic vs laparoscopic vs open)  

3. How many fibroids are likely to be removed, and can some be left behind?  

4. What is my risk of recurrence in the next few years?  

5. If I want pregnancy later, what does this surgery mean for timing and delivery plan?  

6. What recovery restrictions will I have, and for how long?  

Conclusion 

Fibroid removal surgery is part of uterine fibroid treatment when fibroid symptoms—heavy bleeding, anemia, pressure, or fertility-related concerns—are affecting quality of life.  
The main fibroid removal options include hysteroscopic removal for fibroids inside the uterine cavity and myomectomy surgery via laparoscopic/robotic or open abdominal approaches for fibroids in the uterine wall or on the outer surface.  
Each approach has trade-offs in recovery and risk, and myomectomy preserves the uterus but carries recurrence potential, therefore the right decision depends on fibroid location, symptoms, and future pregnancy plans.