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.