Fibroid Treatment Options
There is no single "right" fibroid treatment — only the right treatment for your fibroids, your symptoms, and your goals. Dr. Banooni prioritizes the least invasive option that fully addresses the problem.
| Option | Best for | Uterus preserved | Typical recovery |
|---|---|---|---|
| Watchful waiting | Small, asymptomatic fibroids | Yes | None — periodic imaging |
| Medication | Bleeding/pain management, bridge to surgery | Yes | None |
| Hysteroscopic myomectomy | Submucosal (cavity) fibroids | Yes | Same day – a few days |
| Laparoscopic / robotic myomectomy | Intramural & subserosal fibroids, fertility-preserving | Yes | 2–4 weeks |
| Mini-laparotomy myomectomy | Fertility-preserving, shorter surgical time, cosmetic preference | Yes | 2–4 weeks |
| Abdominal myomectomy | Very large or numerous fibroids | Yes | 4–6 weeks |
| Minimally invasive hysterectomy | Completed childbearing, recurrent/extensive fibroids | No | 2–4 weeks |
Laparotomy vs. Laparoscopy: What's the Difference?
The table above uses "minimally invasive" and "open" a lot — this video breaks down what that distinction actually means for your incision, recovery, and outcomes.
Dr. Peyman Banooni, MD, FACOG · Patient education
Myomectomy
Myomectomy removes fibroids individually while reconstructing and preserving the uterus. It's the standard recommendation for women who want to retain fertility or simply keep their uterus.
Hysteroscopic
For fibroids that bulge into the uterine cavity. Performed through the cervix with no external incisions — often same-day, with return to normal activity within days.
Laparoscopic / Robotic
Small incisions and a magnified 3D view allow precise removal of intramural and subserosal fibroids with less pain and faster recovery than open surgery.
Abdominal (Open)
Reserved for very large fibroids or numerous fibroids where a minimally invasive approach isn't safe or effective. Involves a single larger incision.
Mini-Laparotomy Myomectomy
Mini-laparotomy is a minimally invasive alternative to laparoscopic or robotic myomectomy, performed through a single small incision — typically 4–5 cm — rather than the multiple port incisions used in standard laparoscopic surgery. Dr. Banooni is the lead surgeon for this technique at Cedars-Sinai Medical Center, where he has refined the approach over the course of his practice.
For the right candidates, mini-laparotomy offers the same recovery timeline as laparoscopic or robotic myomectomy, often with a shorter surgical time, and a single, more cosmetically discreet scar in place of several separate incision sites.
Large Fibroid Removal: Techniques & a Real Case
Fibroid size alone doesn't rule out a minimally invasive approach. These two videos cover the range of techniques used for large fibroids, and show one in practice.
Large Uterine Fibroid Removal Techniques · Dr. Peyman Banooni, MD, FACOG
A Huge Fibroid, Removed Through a Small Incision · Dr. Peyman Banooni, MD, FACOG
Hysterectomy
For women who have completed childbearing or have extensive, recurrent fibroid disease, hysterectomy removes the source of the problem permanently. Dr. Banooni performs minimally invasive (laparoscopic or vaginal) hysterectomy whenever it's clinically appropriate, reserving open surgery for cases that require it.
Non-Surgical Management
Medical management
Hormonal therapy (oral contraceptives, progestin IUDs, GnRH antagonists) to reduce bleeding and shrink fibroid-related symptoms, plus iron repletion for anemia.
Uterine fibroid embolization
An image-guided procedure, typically performed by an interventional radiologist, that cuts off blood supply to fibroids. Dr. Banooni will discuss whether this is appropriate for your case and coordinate referral when indicated.
Treatment questions patients ask most
What is the difference between myomectomy and hysterectomy?
A myomectomy removes fibroids while leaving the uterus in place, preserving the ability to carry a pregnancy. A hysterectomy removes the uterus entirely and is a definitive, one-time solution for fibroids, typically reserved for women who do not wish to preserve fertility.
Is myomectomy a major surgery?
It depends on the approach. Hysteroscopic myomectomy for cavity-based fibroids is same-day with minimal recovery. Laparoscopic or robotic myomectomy is more involved but still minimally invasive, typically with a one-night hospital stay and a two-to-four week recovery. Open (abdominal) myomectomy is reserved for very large or numerous fibroids and has a longer recovery.
Can I still get pregnant after a myomectomy?
Yes, myomectomy is specifically designed to preserve fertility potential. Many patients conceive after recovery. Depending on the depth and location of fibroid removal, a subsequent delivery may be recommended by cesarean section.
Are fibroids treatable without surgery?
Yes, for many patients. Hormonal medications, iron supplementation for anemia, and interventions like uterine fibroid embolization can manage symptoms without removing the fibroid surgically. Whether this is appropriate depends on fibroid size, location, and your goals.
What is mini-laparotomy for fibroids?
Mini-laparotomy is a minimally invasive myomectomy technique performed through a single small incision, typically 4–5 cm, rather than the multiple port incisions used in standard laparoscopic surgery. It offers a comparable recovery timeline to laparoscopic or robotic myomectomy, often with a shorter surgical time and a single, more cosmetically discreet scar. Dr. Banooni is the lead surgeon for this technique at Cedars-Sinai Medical Center.
Let's find the least invasive path that works.
Bring your imaging and questions — leave with a specific recommendation.