🔬 Myomectomy vs Hysterectomy Decision Simulator

Patient Assessment

Fibroid size, count and fertility plans drive the surgical choice.

• ~70%: Fibroids in reproductive age (women affected by 50)
• >5 cm: Typical size cutoff (flags surgical complexity)
• Highest: Submucosal fibroids (fertility impact)
• MRI/US: Imaging tool (maps count and location)

Size matters

Larger fibroids raise surgical difficulty and blood loss.

Number matters

More fibroids mean more incisions and longer operating time.

Fertility plans matter most

Future pregnancy desire reshapes the entire decision.

Fertility-Preserving Priority

Myomectomy removes fibroids while keeping the uterus intact.

• ~60%: Pregnancy after myomectomy (conceive within 2 years)
• Preferred: Laparoscopic approach (for smaller fibroids)
• Best: Hysteroscopic approach (for submucosal fibroids)
• 2–4 wks: Recovery time (shorter than open surgery)

Nodule-by-nodule removal

Each fibroid is shelled out individually, sparing healthy tissue.

Route selection

Location and size decide laparoscopic vs hysteroscopic access.

Uterine wall repair

Layered closure restores strength for future pregnancy.

Multiple Large Fibroids

More and bigger fibroids make myomectomy technically harder.

• ~25%: Recurrence rate (within 5 years)
• Higher: Blood loss risk (with multiple nodules)
• More likely: Conversion to open (above 6 fibroids)
• ~10%: Repeat surgery (reoperate for recurrence)

Technical difficulty rises

Each additional nodule adds operative time and risk.

Recurrence risk

New fibroids can regrow after incomplete removal.

Shared decision-making

Patients weigh fertility goals against recurrence odds.

No Fertility Desire, Definitive Treatment

Hysterectomy removes the uterus and ends fibroid recurrence.

• 0%: Recurrence after hysterectomy (uterus fully removed)
• Minimally invasive: Most common approach (laparoscopic/vaginal)
• ~200,000/yr: US fibroid hysterectomies (leading indication)
• Definitive: Symptom relief (no future fibroid growth)

Definitive resolution

Removing the uterus eliminates any chance of new fibroids.

Trade-off

Pregnancy is no longer possible after hysterectomy.

Approach options

Vaginal, laparoscopic or abdominal routes depend on uterine size.

Decision Reached

Fibroid burden and fertility desire together select the approach.

• Fertility: Key factor 1 (desire drives priority)
• Fibroid size: Key factor 2 (shapes technical risk)
• Fibroid count: Key factor 3 (raises recurrence odds)
• Shared: Final call (surgeon and patient decide)

Fertility desire dominates

When pregnancy is wanted, myomectomy usually wins.

Complexity is a modifier

Large fibroid burden raises risk but rarely reverses the choice.

No fertility desire

Hysterectomy becomes the definitive, lowest-recurrence option.