Summary:

  1. Uterine fibroid treatment and options — comparing two uterus-sparing procedures.
  2. Myomectomy removes fibroids entirely — traditional surgery keeping uterus intact.
  3. RFA uses heat to shrink fibroids — less invasive ablation technique.
  4. Recovery faster after RFA — shorter downtime and smaller incisions.
  5. Myomectomy better for fertility goals — stronger evidence when pregnancy desired.
  6. Choice depends on symptoms and goals — size, number, and personal priorities.

 

If you’ve been told, you have uterine fibroids—and you’re weighing your treatment options—first, know that you are not alone . Fibroids (also called leiomyomas) affect a large number of women in the U.S., especially during the reproductive years. These growths can cause heavy or prolonged menstrual bleeding, pelvic pressure or pain, urinary frequency, sometimes fertility issues or pregnancy complications. So it’s absolutely valid to ask: What’s the best treatment for me ?

In the past decade, we’ve seen real advances in uterus-sparing fibroid treatments—meaning women don’t automatically have to consider a full hysterectomy. Two of the options you may hear are: myomectomy surgery (removing the fibroids) and laparoscopic radiofrequency ablation (RFA) (shrinking them with heat). In this article I’ll walk you through how each works, what you might expect afterward, and some of the key questions you should be asking—and we’ll anchor things in U.S. research and clinical practice so you feel confident in your decision.

What is a Myomectomy?

When someone uses the term “myomectomy,” they mean surgery to remove fibroids while keeping the uterus intact. Simply put: the fibroids come out, the uterus remains. This is a big benefit for many women—especially those who want to preserve fertility or just retain their uterus for personal or hormonal reasons. According to the Mayo Clinic, this is one of the key reasons myomectomy is recommended over a hysterectomy in the right patient.

There are several approaches depending on how many fibroids you have, how large they are, and where they are.

Abdominal (open) myomectomy : A larger incision in your lower abdomen. Used when there are large or numerous fibroids.

Laparoscopic (or robotic-assisted) myomectomy : Smaller incisions, camera-guided, less extensive recovery in favorable cases.

Hysteroscopic myomectomy : No abdominal incisions—access via the vagina/cervix to remove fibroids protruding into the uterine cavity. Good for certain submucosal fibroids.

How does the process work in an abdominal myomectomy?

Here’s a human-friendly breakdown:

  1. You’re under general anesthesia.
  2. The surgeon makes a lower abdomen incision to reach the uterus.
  3. Cuts are made in the uterine muscle where the fibroids sit.
  4. The fibroids are “shelled out” (enucleated) from the muscle wall.
  5. The uterine wall is carefully repaired in layers (this is critical for future pregnancy safety).
  6. Incision closed.

Because the muscle is cut and repaired, many doctors recommend waiting a certain time (often 3–6 months) before attempting pregnancy so the uterus can heal.

Why choose myomectomy?

It is the traditional “go-to” when fertility preservation is important.

It removes visible fibroids entirely, which can be helpful if one or two large fibroids are causing bleeding, pain or infertility.

U.S. practice guidelines (American Academy of Family Physicians, others) show improved symptoms and quality of life after myomectomy.

But it’s not without considerations. Risks include blood loss, scar tissue (adhesions), infection and the fact that new fibroids may develop later (because surgery doesn’t remove the root cause). One recent review reminded us that myomectomy is among the most “adhesiogenic” gynecologic surgeries—meaning scar tissue and adhesions are a real risk, and this can impact fertility in some cases.

Understanding Laparoscopic Radiofrequency Ablation (RFA)

Now let’s talk about a different approach: RFA. The good news: this is less invasive in many cases. The version used for fibroids in U.S. centers like University of Chicago Medicine (UIC) is called Acessa or Sonata, depending on access method.

How it works:

Under general anesthesia, the surgeon makes a couple of tiny abdominal incisions (for Acessa) or uses a transcervical device (Sonata) for ablation without external incisions. A thin needle or probe is inserted into the fibroid and radiofrequency energy (heat) is delivered to destroy the fibroid tissue.

Over the next weeks to months, your body gradually absorbs the treated fibroid tissue and shrinks the fibroid. Symptoms improve as volume decreases.

Benefits of RFA:

Minimally invasive: smaller cuts or even no cuts (in the transcervical version).

Shorter recovery: many patients go home same-day or next day, back to light activity in days rather than weeks. Less bleeding than some surgical procedures.

Preservation of the uterus: you keep your uterus, which is important from a psychological and hormonal standpoint.

Limitations to know:

Because the fibroid is not removed entirely (it’s ablated/shrunk), the long-term fertility and pregnancy data are still less robust compared to myomectomy. The UChicago team notes that for women wanting to conceive, myomectomy remains the recommended option. Not every fibroid can be treated with RFA: very large fibroids, those in certain locations, or multiple fibroids may not be ideal candidates.

Future fibroid development risk remains (as with any uterus-sparing procedure).

Some newer studies show RFA may match symptom relief of myomectomy in selected cases, but selection is key. For example, a thermal ablation vs myomectomy comparison suggested that ablative methods “were not inferior” in some symptom treatment contexts—but this doesn’t directly speak to pregnancy outcomes.

Key Differences: Myomectomy vs RFA

Here’s a side-by-side comparison to help you think:

What the procedure does

  1. Myomectomy: removes the fibroid(s) from the uterus; you wake up with them gone.
  2. RFA: uses heat to destroy fibroid tissue; the fibroid shrinks over time inside your uterus.

Recovery

  1. Myomectomy (especially open): longer stay in hospital, heavier recovery, more pain possible, longer downtime.
  2. RFA: often outpatient, lighter downtime, faster return to work or regular life.

Fertility / Pregnancy

  1. Myomectomy: proven track record for fertility in certain fibroid-related infertility cases.
  2. RFA: promising for symptom relief, but less robust data for pregnancy outcomes; many specialists are cautious about recommending it when pregnancy is the immediate goal.

Risks and recurrence

  1. Myomectomy: risk of bleeding, scarring/adhesions, potential future fibroid growth. Research shows adhesions are a considerable concern.
  2. RFA: lower surgical risk in many cases, less downtime, but suitability depends heavily on fibroid characteristics and fertility goals.

Body Changes After Myomectomy

If you go down the myomectomy path, here’s what many women tell me they notice in the weeks and months after surgery—both physically and emotionally:

  1. Lighter, more predictable periods : If you had heavy bleeding or large clots before, many women find a significant improvement once the offending fibroids are gone.
  2. Reduced pelvic pressure or fullness : Large fibroids can press on bladder or bowel, make you feel “full” or bloated. Post-surgery, that sensation often fades, and you feel physically lighter.
  3. Incision healing : Whether open or laparoscopic, healing takes time. With smaller incisions (lap/robotic) the scar is less prominent and recovery faster—but the uterus still needs healing.
  4. Menstrual cycle normalization : Once healing is complete, your cycle often becomes more regular. If you plan pregnancy, many doctors suggest waiting 3–6 months to allow the uterine wall to heal.
  5. Emotional lift : Many women say simply feeling like they’ve done something proactive—reclaiming their body and control—makes a big difference. The symptom burden (bleeding, fatigue, annoyance of constant monitoring) lifts.

That said, healing isn’t overnight. It takes patience, and for women who had large fibroids or major surgery, it may take a few months to feel “back to normal.”

How to Choose the Right Treatment

Here’s how I guide my patients through this in my Chicago practice—so you can go in to your consultation with the right questions and mindset.

Ask yourself (and your doctor):

  1. What size are the fibroids? How many? Where are they located? (intramural, submucosal, subserosal)
  2. What are your symptoms? Is bleeding your primary concern, or pressure/bulk symptoms, or fertility issues?
  3. Are you hoping to have children (soon or later)? Or are you done with childbearing and looking more for symptom relief and quick recovery?
  4. What is your general health status? Have you had prior surgery, scar tissue, anemia from bleeding, etc.?
  5. What is the surgeon’s/center’s experience with each procedure?

When might myomectomy make more sense?

If you are wanting to conceive, especially if fibroids are distorting the uterine cavity or interfering with fertility.

If there are large fibroids or many fibroids that may not be ideal for ablation.

If you are okay with the longer recovery in exchange for maximal removal.

When might RFA be a strong alternative?

  1. If your fibroids are moderate size, accessible, and you’re more focused on symptom relief and minimal downtime than immediate pregnancy.
  2. If you prefer a very short recovery time and reduced invasiveness.
  3. If you’ve completed childbearing or fertility is less urgent.

Important: get a second opinion (if needed). Fibroids are very individual. What worked for one woman may not work for another. A center that specializes in fibroid management (such as the CATeR Fibroid Center at UChicago) can help assess advanced options and research.

The Bottom Line

Fibroids don’t have to control your life. Knowing your options—and having one-on-one time with a gynecologist you trust—makes all the difference.

  1. If pregnancy or fertility is high on your list: myomectomy remains the gold standard in many cases.
  2. If you’re mainly seeking symptom relief , want a faster recovery , and fertility is not your immediate goal: then laparoscopic RFA could be very attractive.

Both approaches offer the chance to keep your uterus, avoid a hysterectomy (if that aligns with your goals), and regain a better quality of life.

If you’re in Chicago or the surrounding region and scheduling a consult, I welcome you. We’ll walk through your imaging, your full medical history, and your personal life goals—so you leave our visit with a clear plan and confidence, not confusion. At [drshehrebanu.com](https://drshehrebanu.com), you’ll find more details about scheduling.

Your body, your future, your choices—with accurate information and a thoughtful partner in your care. Let’s chart the path toward relief and future well-being together.