Myomectomy Vs Hysterectomy: What To Know Before You Decide

When your gynaecologist mentions two treatments, where one removes your fibroids and the other removes your uterus, you may start asking yourself: “If I keep my uterus, will the fibroids just come back? And if I choose to remove the uterus, how will it affect me?”

These questions are important when you are deciding whether to have a myomectomy or a hysterectomy. So let's look at how the two operations compare and what’s worth considering before taking your next step.

What is a myomectomy?

A myomectomy, also known as fibroidectomy, is a surgery to remove uterine fibroids while preserving your uterus. It aims to relieve symptoms such as heavy menstrual bleeding and pain or pressure in your lower abdomen. It may be a suitable option if you wish to carry a pregnancy in the future or prefer to keep your uterus.

There are four surgical approaches to myomectomy:

• Hysteroscopic: Your surgeon passes a thin instrument called a hysteroscope through your vagina and cervix to remove suitable fibroids that extend into the uterine cavity. No abdominal incisions are needed. It generally has a shorter recovery time than open abdominal surgery.
• Laparoscopic: Your surgeon operates through small incisions in your abdomen using a laparoscope (a thin scope with a camera) and other surgical instruments. Compared with open abdominal surgery, it generally involves less postoperative pain and a shorter recovery.
• Robotic-assisted: Your surgeon operates through small abdominal incisions using robotic instruments controlled by your surgeon from a nearby console. It may allow a shorter recovery time than open abdominal surgery, but the procedure can take longer and cost more than conventional laparoscopy.
• Open abdominal: Your surgeon accesses the fibroids through a larger incision in your lower abdomen. It may be recommended for large or numerous fibroids, and usually involves a longer hospital stay and recovery than keyhole surgery.

Your gynaecologist will recommend an approach based on the size, number and location of your fibroids, your overall health and your pregnancy plans. Myomectomy preserves the possibility of carrying a pregnancy, but it does not guarantee that you will conceive.

What is a hysterectomy?

​A hysterectomy is a surgery to remove your uterus. Depending on the reason for the surgery, the procedure may also remove the fallopian tubes, cervix (neck of the uterus), and one or both of the ovaries.

Your gynaecologist may recommend this procedure for conditions such as fibroids, adenomyosis, severe endometriosis and other non-cancerous growths.

There are three types of hysterectomy:

• Total hysterectomy: Your surgeon removes your entire uterus and cervix. This does not automatically include removal of the ovaries or fallopian tubes.
• Subtotal hysterectomy (partial or supracervical hysterectomy): Your surgeon removes the main body of the uterus while leaving the cervix in place. This type is less commonly performed.
• Radical hysterectomy: Your surgeon removes the uterus, cervix, upper part of the vagina, surrounding tissues, and sometimes the nearby lymph nodes. It is commonly performed for certain cancer treatments, such as cervical cancer.

A hysterectomy can be performed vaginally (through the vagina, with no abdominal incision), laparoscopically, with robotic assistance, or through open abdominal surgery. The laparoscopic, robotic and open approaches are similar to those used for myomectomy, except that the uterus is removed.

Your gynaecologist will recommend an approach based on your condition, uterine size, previous surgery and other individual factors. After a hysterectomy, you can no longer carry a pregnancy, so your pregnancy plans should be discussed before deciding on the procedure.

Myomectomy vs hysterectomy: Key differences

Here’s how the two procedures compare side by side, including their treatment goals and effects on future pregnancy.

How long will recovery take?

How your surgery is done affects recovery more than which operation you have. A keyhole hysterectomy can be an easier recovery than an open myomectomy.

• Hysteroscopic (myomectomy only): Usually a day procedure. Most people are back to their normal routine within a few days.
• Keyhole (laparoscopic or robotic) or vaginal: Usually one to three days in hospital. Light activities such as short walks are often possible within the first week or two, and full recovery takes about four to six weeks.
• Open abdominal: A longer hospital stay and a longer recovery, usually about six to eight weeks, with a larger scar.

If you’re hoping to get pregnant after a myomectomy, there’s a second, longer timeline. Your uterus needs several months to heal before you start trying, and how long depends on how deep the repair was. Ask about this before surgery, as it may affect when you choose to have it.

Will fibroids come back after a myomectomy?

They can. A myomectomy removes the fibroids you have now, but your uterus can still grow new ones. Some women need further treatment years later, while others never do.

Your own chances depend mainly on two things:

• How many fibroids you had. New fibroids are more likely if several were removed than if there was only one.
• How far you are from menopause. Fibroids depend on oestrogen and usually shrink after menopause, so the closer you are to it, the less time new fibroids have to grow.

Whether that risk matters depends on what you want from treatment. If keeping your uterus or the option of pregnancy is important to you, the chance of needing treatment again may be worth accepting. If your family is complete and you’d rather not deal with fibroids again, a hysterectomy removes that possibility, but it also means you can no longer carry a pregnancy.

A useful question to ask your gynaecologist: “Given the number of fibroids I have and my age, how likely am I to need treatment again?”

Possible risks of myomectomy and hysterectomy

Both myomectomy and hysterectomy carry the risks of:

• Bleeding and blood loss
• Blood clots
• Infection
• Injury to nearby organs such as the bladder, ureters, or bowel
• Complications from anaesthesia
• Internal scar tissue, also called adhesions

Your individual risks depend on the surgical approach, the complexity of the procedure, and your overall health.

Risks associated with myomectomy

During hysteroscopic myomectomy, there is a risk of uterine perforation, an accidental hole through the uterine wall. This is different from uterine rupture, a rare tear that can occur during a later pregnancy or labour after surgery involving the uterine muscle. Your gynaecologist can explain whether your operation may affect the management of a future pregnancy or birth.

In some cases, a myomectomy may need to be converted to a hysterectomy during the operation, for example if bleeding cannot be controlled. This is uncommon, but if keeping your uterus is important to you, ask your surgeon about this risk beforehand.

Risks and effects associated with hysterectomy

• One possible complication after hysterectomy is vaginal vault prolapse, where the top of the vagina descends because its supporting tissues have weakened. If the procedure involves removing both ovaries before natural menopause, surgical menopause will occur and may cause symptoms such as hot flushes and vaginal dryness.
• Emotional impact, such as grief or anxiety regarding body image or fertility loss, may also occur.

If you have been advised to consider myomectomy or hysterectomy and would like a second opinion, contact our Care Team on WhatsApp. Share what you have been advised and any relevant scan or test reports. We will suggest one to three gynaecologists, explain why each may suit your needs, and help arrange an appointment with your preferred doctor.

Alternatives to myomectomy and hysterectomy

You may have other options, particularly if surgery is being considered for fibroids. Whether they are suitable depends on your symptoms, scan findings, previous treatment and pregnancy plans. The following treatments are mainly alternatives for fibroids. They are not substitutes for hysterectomy in every situation.

• Hormonal IUDs and medication can help manage symptoms such as heavy menstrual bleeding and painful periods. However, symptom relief does not necessarily mean the underlying conditions have been treated.
• Uterine fibroid embolisation (UFE), also known as uterine artery embolisation (UAE), reduces the blood supply to fibroids, helping them shrink and relieving symptoms such as heavy bleeding and pelvic pressure.
• Radiofrequency ablation uses controlled heat to shrink fibroids and reduce symptoms.
• Focused ultrasound ablation uses ultrasound waves to destroy the fibroid tissue. 

If you’re planning a pregnancy, tell your gynaecologist. There is less evidence on pregnancy after UFE, radiofrequency ablation and focused ultrasound than after myomectomy, so these may not be the first option if you want to conceive.

Your gynaecologist can explain which of these alternative options are suitable to treat your condition and what each procedure involves.

What each procedure may cost in Singapore

The costs of myomectomy and hysterectomy can overlap. Your hospital, ward class, and the complexity of your operation all affect the final bill.

Based on MOH’s published inpatient bill ranges for selected myomectomy and hysterectomy procedures, the approximate costs are:

• About $2,500 to $7,600 in a subsidised public hospital ward (B2 or C)
• About $10,000 to $17,000 in an unsubsidised public hospital ward (B1 or A)
• About $23,000 to $35,000 in a private hospital

Because MOH’s bill ranges for complicated myomectomy and two hysterectomy categories are similar, the rounded figures above combine all three. They do not cover every surgical approach, and individual bills may fall outside them.

The figures include GST and reflect bills for Singapore citizens. Government subsidies are already included where applicable, but insurance and MediSave payments have not been deducted. Your remaining cash payment depends on the benefits and MediSave amount you can use.

Ask your hospital for a written estimate for your planned procedure, including the expected stay and any additional procedures. These published figures are a guide, not a quotation.

How Health in Asia can help

The hospital bill for either operation can look similar, but what you pay yourself depends on your ward, your insurer’s panel and whether pre-authorisation applies. Those details rarely come up until after you’ve chosen, and they’re easier to weigh beforehand.

Tell our Care Team about your symptoms, the treatment recommended so far, and whether keeping your uterus matters to you. You can also share scan reports, previous treatments and your insurance details.

The Care Team can help with:

• A shortlist of one to three gynaecologists matched to your condition and preferences, with the reasons explained
• Checking your insurer’s panel eligibility, likely coverage and whether pre-authorisation applies
• Explaining estimated out-of-pocket costs before you book
• Appointment booking and care coordination
• Arranging a second opinion on the need for surgery or the recommended approach

We help you navigate your care, but we do not diagnose your condition or decide which treatment you need. Your gynaecologist will discuss which treatment is right for you.