Fibroids can be removed through several methods, ranging from minimally invasive procedures you recover from in days to major surgery requiring weeks of downtime. The right approach depends on your fibroids’ size, number, and location, as well as whether you want to preserve your uterus. Here’s what each option involves and what recovery actually looks like.
Surgical Removal: Myomectomy
Myomectomy removes fibroids while keeping the uterus intact, making it the standard choice for women who want to preserve fertility or simply prefer to keep their uterus. There are three main surgical routes, and the one your surgeon recommends will depend largely on where your fibroids sit and how big they are.
Hysteroscopic Myomectomy
This is the least invasive surgical option, but it only works for fibroids that bulge into the uterine cavity (called submucosal fibroids). A thin scope is passed through the vagina and cervix with no external incisions at all. Fibroids up to about 3 centimeters have a single-step success rate near 89%, meaning the surgeon can remove the entire fibroid in one procedure. Larger fibroids may need a second procedure to finish the job. Recovery is measured in days rather than weeks, and most women go home the same day.
Laparoscopic and Robotic Myomectomy
For fibroids embedded in the uterine wall or growing on the outer surface, laparoscopic myomectomy uses a few small incisions in the abdomen. An experienced surgeon can perform this regardless of fibroid size, number, or location, though very large or numerous fibroids sometimes make the open approach more practical.
Robotic-assisted myomectomy uses the same small incisions but adds a robotic system that gives the surgeon enhanced precision. Both approaches result in a median blood loss of about 100 mL, roughly half of what open surgery typically produces. The tradeoff with robotic surgery is time: median operating time is about 140 minutes compared to 70 minutes for standard laparoscopic surgery. However, robotic patients need blood transfusions less often (6% versus 12% for laparoscopic and 26% for open surgery).
You can typically go home the same day after a laparoscopic or robotic procedure, with full recovery taking two to four weeks.
Open (Abdominal) Myomectomy
When fibroids are very large or when there are many of them scattered throughout the uterus, open surgery through a larger abdominal incision is sometimes the best option. The surgeon can feel the uterus directly, which helps locate fibroids that might be missed with a camera alone. Expect a hospital stay of a few days and up to six weeks at home before you feel fully recovered.
Uterine Artery Embolization
Uterine artery embolization (UAE) shrinks fibroids by cutting off their blood supply. An interventional radiologist threads a thin catheter through a small puncture in the wrist or groin and injects tiny particles into the arteries feeding the fibroids. No abdominal incision is needed.
The procedure has a success rate around 95%. After 12 months, the dominant fibroid typically shrinks by about 52% in diameter and the uterus itself decreases in size by roughly 56%. Symptom relief is substantial: heavy bleeding improves in about 92% of cases, pelvic pain in 84%, and urinary pressure symptoms in 85%. Recovery is generally one to two weeks. UAE is a strong option for women who want to avoid surgery but aren’t necessarily planning a pregnancy, since its effects on future fertility aren’t fully established.
MRI-Guided Focused Ultrasound
This is the only completely noninvasive option. You lie inside an MRI machine while concentrated ultrasound waves heat and destroy fibroid tissue through the skin, with no needles, catheters, or incisions. It sounds ideal, but eligibility is limited. In screening studies, a significant proportion of women were excluded: 33% because they had more than six fibroids, 9% because a fibroid exceeded 10 centimeters, and others because fibroids were calcified, located too deep, or because of conditions like adenomyosis. You’ll need an MRI screening to determine whether your specific fibroids are treatable this way.
Radiofrequency Ablation
Radiofrequency ablation (sold under the brand name Acessa) destroys fibroids from the inside using heat delivered through a small probe. A surgeon inserts the probe through a tiny laparoscopic incision while using ultrasound to map each fibroid precisely. The heat destroys fibroid tissue while sparing the surrounding uterine muscle, leaving only a 3.4-millimeter puncture track. The treated fibroid tissue is gradually reabsorbed by the body over the following months.
This approach works for fibroids up to 7 centimeters in diameter. Fibroids that dangle on a stalk inside the uterine cavity are better handled by hysteroscopy instead. One important note: this procedure is not recommended for women planning a future pregnancy, as there isn’t enough safety data on how the treated uterine tissue handles the stress of pregnancy.
Medication to Shrink Fibroids Before Surgery
Hormonal medications can temporarily shrink fibroids before a procedure, making surgery easier and reducing blood loss. The most established approach uses a class of drugs that suppresses estrogen production, typically given as injections for two to three months before surgery. These medications shrink fibroid volume by a median of 35% to 58%, which can make the difference between needing open surgery and qualifying for a minimally invasive approach. The shrinkage is temporary. Fibroids regrow once you stop the medication, so these drugs are used as a bridge to surgery rather than a standalone treatment.
Hysterectomy as a Last Resort
Removing the uterus entirely is the only option that guarantees fibroids will never come back. It’s generally reserved for women who are near or past menopause, have very large fibroids, experience extremely heavy bleeding that hasn’t responded to other treatments, or simply don’t want to deal with the possibility of recurrence. Like myomectomy, hysterectomy can be performed through small incisions (laparoscopic or robotic) or through an open abdominal approach, depending on uterine size.
Recurrence After Fibroid Removal
One reality that catches many women off guard: fibroids can grow back. After myomectomy, 15% to 33% of women develop new fibroids over the following years. About 10% to 21% of women ultimately need a hysterectomy within five to ten years of their original myomectomy, and 12% require some form of reoperation, with an average gap of about eight years between procedures. This doesn’t mean myomectomy was the wrong choice. Many women get years of symptom relief and successfully complete pregnancies before needing further treatment. But it’s worth knowing upfront that “removal” doesn’t always mean permanent resolution unless the uterus itself is removed.
Choosing the Right Approach
The best removal method isn’t the same for everyone. A few key factors drive the decision:
- Fibroid location: Fibroids bulging into the uterine cavity are best suited for hysteroscopy. Those embedded in the wall or on the outer surface need laparoscopic, robotic, or open surgery.
- Fibroid size and number: A single 2-centimeter fibroid is a different situation than ten fibroids of varying sizes. Focused ultrasound and radiofrequency ablation have upper limits on size and number. Very large or numerous fibroids often point toward open myomectomy or embolization.
- Pregnancy plans: Myomectomy (any type) is the go-to for women planning future pregnancies. Radiofrequency ablation and embolization aren’t well studied for fertility preservation.
- Tolerance for recurrence: If the idea of needing a second procedure in several years is unacceptable, hysterectomy is the only guaranteed permanent solution.
- Recovery time available: If you need to return to work quickly, hysteroscopic myomectomy (days of recovery) or laparoscopic approaches (two to four weeks) are far more practical than open surgery (six weeks).