Hysterectomy vs myomectomy

Hysterectomy removes the uterus, so periods stop and pregnancy is no longer possible afterward. Depending on the operation, the cervix, fallopian tubes or ovaries may also be discussed separately. Myomectomy removes fibroids while preserving the uterus, although new fibroids can develop later. Either operation may be performed through an abdominal, laparoscopic or hysteroscopic route, depending on fibroid size, number and position.

Hysterectomy may be considered when fibroid symptoms are severe, other treatments have not helped, and future pregnancy is not wanted or is not possible. It can provide a definitive treatment for the uterus and stops uterine bleeding. The operation may still require decisions about the cervix, tubes and ovaries; removing the ovaries can affect hormones and is a separate issue from removing the uterus. Read [Hysterectomy](/treatments/gynaecological-surgery/hysterectomy/).

Myomectomy may be considered when fibroids are responsible for heavy bleeding, pressure, pain or fertility problems and preserving the uterus matters. The route depends on whether fibroids bulge into the cavity, sit within the muscle or extend outward. Removing every fibroid may not be possible or helpful, and future pregnancy planning can require specific advice about healing and delivery. Learn about [Myomectomy](/treatments/gynaecological-surgery/myomectomy/).

Both procedures involve anaesthesia, bleeding, infection, blood clots and injury to nearby organs as possible complications. Hysterectomy permanently ends the ability to carry a pregnancy. Myomectomy can leave scar tissue, and fibroids may recur; bleeding during surgery may occasionally require a change in the planned procedure. Recovery varies with the route and the operation. Ask when driving, lifting, intercourse and work can safely resume.

Surgery may not be appropriate when symptoms are mild, the diagnosis is uncertain, or a less invasive option is likely to meet the goal. Medicines, an intrauterine system, uterine artery procedures, focused imaging-guided treatment or observation may be discussed. Rapidly increasing abdominal swelling, severe pain, fainting or very heavy bleeding needs urgent medical assessment rather than routine surgical planning.

The surgeon considers symptoms, imaging, fibroid location, uterine size, anaemia, previous operations, general health and pregnancy plans. They explain which organs would be removed or preserved, the likely route, alternatives, recovery and how the choice could affect future fertility. Ask whether treatment is aimed at bleeding, pressure, pain or fertility, because the best procedure for one goal may not be the best for another.