Your doctor might recommend myomectomy for fibroids causing symptoms that are troublesome or interfere with your normal activities. If you need surgery, reasons to choose a myomectomy instead of a hysterectomy for uterine fibroids include:

You plan to bear children

Your doctor suspects uterine fibroids might be interfering with your fertility

You want to keep your uterus

Myomectomy has a low complication rate. Still, the procedure poses a unique set of challenges. Risks of myomectomy include:

Excessive blood loss. Many women with uterine leiomyomas already have low blood counts (anemia) due to heavy menstrual bleeding, so they're at a higher risk of problems due to blood loss. Your doctor may suggest ways to build up your blood count before surgery.

During myomectomy, surgeons take extra steps to avoid excessive bleeding. These may include blocking flow from the uterine arteries by using tourniquets and clamps and injecting medications around fibroids to cause blood vessels to clamp down. However, most steps don't reduce the risk of needing a transfusion.

Scar tissue. Incisions into the uterus to remove fibroids can lead to adhesions — bands of scar tissue that may develop after surgery. Robotic myomectomy may result in fewer adhesions than abdominal myomectomy (laparotomy).

Pregnancy or childbirth complications. A myomectomy can increase certain risks during delivery if you become pregnant. If your surgeon had to make a deep incision in your uterine wall, the doctor who manages your subsequent pregnancy may recommend cesarean delivery (C-section) to avoid rupture of the uterus during labor, a very rare complication of pregnancy. Fibroids themselves are also associated with pregnancy complications.

Rare chance of hysterectomy. Rarely, the surgeon must remove the uterus if bleeding is uncontrollable or other abnormalities are found in addition to fibroids.

To minimize risks of myomectomy surgery, your doctor may recommend:

Iron supplements and vitamins

Hormonal treatment Your doctor may prescribe a gonadotropin-releasing hormone (GnRH) agonist, birth control pills or other hormonal medication to stop or decrease your menstrual flow.

Therapy to shrink fibroids. Some hormonal therapies, such as GnRH agonist therapy, can also shrink your fibroids and uterus enough to allow your surgeon to use a minimally invasive surgical approach — robotic procedure instead of an open procedure.

You'll need to fast — stop eating or drinking anything — in the hours before your surgery. Follow your doctor's recommendation on the specific number of hours.

If you're on medications, ask your doctor if you should change your usual medication routine in the days before surgery. Tell your doctor about any over-the-counter medications, vitamins or other dietary supplements you're taking.

Depending on your procedure, you may receive one of the following types of anesthesia:

General anesthesia. With general anesthesia, you will be fully asleep and a tube will be placed in your throat. General anesthesia is used for robotic myomectomy and usually for abdominal myomectomy; it is sometimes also used for hysteroscopic myomectomy.

Whether you stay in the hospital for just part of the day or overnight depends on the type of procedure you have. Abdominal myomectomy (laparotomy) usually requires a hospital stay of one to two days. In most cases, robotic myomectomy is done outpatient or with only one overnight stay.

Your facility may require that you have someone accompany you on the day of surgery. Make sure you have someone lined up to help with transportation and to be supportive.

Depending on the size, number and location of your fibroids, your surgeon may choose one of three surgical approaches to myomectomy.

In abdominal myomectomy (laparotomy), your surgeon makes an open abdominal incision to access your uterus and remove fibroids. Your surgeon will generally prefer to make a low, horizontal ("bikini line") incision, if possible. Vertical incisions are needed for larger uteruses.

In Robotic myomectomy, both minimally invasive procedures, your surgeon accesses and removes fibroids through several small abdominal incisions.

Compared with women who have a laparotomy, women who undergo Robotic myomectomy have less blood loss, shorter hospital stays and recovery, and lower rates of complications and adhesion formation after surgery

Your surgeon inserts instruments through small incisions, and then controls movement of the instruments from a separate console.

Sometimes, the fibroid is cut into pieces (morcellation) and removed through a small incision in the abdominal wall. Other times the fibroid is removed through a bigger incision in your abdomen so that it can be removed without being cut into pieces. Rarely, the fibroid may be removed through an incision in your vagina (colpotomy).

To treat smaller fibroids that bulge significantly into your uterus (submucosal fibroids), your surgeon may suggest a hysteroscopic myomectomy. Your surgeon accesses and removes the fibroids using instruments inserted through your vagina and cervix into your uterus.

A hysteroscopic myomectomy generally follows this process:

Your surgeon inserts a small, lighted instrument through your vagina and cervix and into your uterus. He or she will most commonly use either a wire loop resectoscope to cut (resect) tissue using electricity or a hysteroscopic morcellator to manually cut the fibroid with a blade.

A clear liquid, usually a sterile salt solution, is inserted into your uterus to expand your uterine cavity and allow examination of the uterine walls.

Your surgeon shaves pieces from the fibroid using the resectoscope or the hysteroscopic morcellator, taking out the pieces from the uterus until the fibroid is completely removed. Sometimes large fibroids can't be fully removed in one surgery, and a second surgery is needed.

Outcomes from myomectomy may include:

Symptom relief. After myomectomy surgery, most women experience relief of bothersome signs and symptoms, such as excessive menstrual bleeding and pelvic pain and pressure.

Fertility improvement. Women who undergo laparoscopic myomectomy, with or without robotic assistance, have good pregnancy outcomes within about a year of surgery. After a myomectomy, suggested waiting time is three to six months before attempting conception to allow your uterus time to heal.

Fibroids could eventually grow and cause symptoms. New fibroids, which may or may not require treatment, can also develop. Women who had only one fibroid have a lower risk of developing new fibroids — often termed the recurrence rate — than do women who had multiple fibroids. Women who become pregnant after surgery also have a lower risk of developing new fibroids than women who don't become pregnant.

Some women with new or recurring fibroids may choose a hysterectomy if they have completed childbearing.