Surgery for fibroids is not a default or a last resort. It is a specific clinical recommendation that is appropriate in specific circumstances — and when those circumstances are present, surgery is frequently the most effective and most durable path to meaningful relief. Understanding when surgery crosses from option to recommendation, what surgical procedures are available, and what the experience of each procedure actually involves is the foundation of a well-informed decision.
The surgical decision for fibroids is never made in a single appointment on the basis of fibroid size alone. It emerges from the intersection of fibroid characteristics, symptom severity, quality of life impact, prior treatment history, reproductive goals, and a patient’s own preferences regarding the level of intervention she is willing to consider. No two patients reach the surgical conversation from exactly the same starting point, and no two surgical recommendations should be identical.
This page covers the specific criteria that guide surgical recommendations at Lapeer Women’s Health, the surgical procedures available, how each procedure differs in its approach and outcomes, and what the surgical experience looks like from consultation through recovery. If you are at the point in your fibroid journey where surgery is on the table — whether as a recommendation you have received, a question you are considering, or a second opinion you are seeking — this page is designed to give you the information you need to move forward with clarity.
Surgery is not appropriate for every fibroid patient — but it is the right recommendation when any of the following conditions are present. These are the criteria that guide the surgical conversation at Lapeer Women’s Health.
Medical Management Has Not Provided Adequate Relief
When hormonal medications, non-hormonal treatments such as tranexamic acid, or a hormonal IUD have been appropriately tried and have not reduced bleeding or symptoms to a level that is acceptable to the patient, surgical treatment becomes the appropriate next discussion. Medical management is a legitimate first-line approach for many fibroid patients — but it is not a permanent solution for most, and its failure to provide adequate relief is one of the clearest indicators that a surgical conversation is warranted.
Bleeding Has Produced Significant Iron-Deficiency Anemia
Chronic heavy menstrual bleeding from fibroids that has produced significant iron-deficiency anemia — particularly when anemia is severe, when iron supplementation has not been adequate to correct it, or when anemia is affecting the patient’s energy, cognitive function, and quality of life — is a strong indication for surgical intervention. Treating the anemia without treating the bleeding source is an indefinite holding pattern, not a solution. Surgery that eliminates or significantly reduces the bleeding source is the most effective long-term approach to resolving fibroid-related anemia.
Fibroids Are Significantly Affecting Quality of Life
When fibroid symptoms — whether bleeding, pressure, bladder urgency, back pain, abdominal distension, pain during intercourse, or a combination — are significantly disrupting daily activities, work, exercise, travel, sleep, or relationships, and the patient has determined that her current quality of life is not acceptable, surgery is an appropriate consideration. Quality of life is a legitimate and sufficient reason to pursue surgical treatment. A patient does not need to reach a threshold of medical severity — she needs to reach a threshold of personal impact that she is no longer willing to accept.
Fibroids Are Contributing to Fertility Challenges
Submucosal fibroids that distort the uterine cavity are associated with implantation failure and early pregnancy loss. Intramural fibroids that significantly alter the shape of the uterine cavity may also affect fertility outcomes. For women who are trying to conceive and have not been successful, or who have experienced recurrent pregnancy loss, myomectomy to remove the relevant fibroids is a surgical option with documented benefit for fertility outcomes. The surgical recommendation in this context is made in coordination with a thorough fertility evaluation to ensure that fibroids are the primary correctable contributing factor.
Fibroid Growth Is Rapid or the Uterus Has Reached a Significant Size
Fibroids that are growing rapidly over a short period, or a fibroid uterus that has enlarged significantly, warrant both careful evaluation and a more active treatment conversation. While the concern about rapid fibroid growth and uterine sarcoma is frequently overstated — uterine sarcoma is rare, and most rapidly growing uterine masses in women of reproductive age are benign fibroids — significant uterine enlargement does produce mechanical symptoms that benefit from surgical treatment, and rapid growth is a factor that appropriately shifts the risk-benefit calculation toward intervention.
The Patient Has Made an Informed Choice for Surgical Treatment
A well-informed patient who has considered all available options and has decided that surgical treatment is the right choice for her — based on her symptoms, her goals, her stage of life, and her own values about her body and her care — is a surgical candidate. Surgery does not require a specific severity threshold that the patient must reach before her preference is respected. It requires that the decision be made with full information about the procedure, its risks and benefits, the alternatives, and the expected outcomes. That is what the surgical consultation at Lapeer Women’s Health is designed to provide.
You do not need a referral from another provider to schedule a fibroid surgical consultation with Dr. Andrei. Contact either office directly to get started. If you have existing imaging or records from prior evaluations, bringing them to your appointment will help — but they are not required.
- Lapeer Office — 1245 N Main St, Lapeer, MI 48446
- Rochester Hills Office — 2710 S Rochester Rd, Suite 2, Rochester Hills, MI 48307
- Surgery performed at McLaren Lapeer Region, Beaumont Hospital Royal Oak, and Crittenton Hospital
The appropriate surgical procedure depends on fibroid type and location, the number and size of fibroids involved, reproductive goals, and the degree of surgical complexity involved in any given patient’s anatomy. The following covers each surgical approach available at Lapeer Women’s Health, including how the procedure is performed, who it is most appropriate for, and what recovery looks like.
Hysteroscopic Myomectomy — For Submucosal Fibroids
Hysteroscopic myomectomy removes fibroids that project into the uterine cavity using a thin instrument passed through the cervix. No abdominal incisions are made. The procedure is performed under anesthesia as an outpatient procedure and typically allows return to normal activities within a few days. It is the most targeted surgical approach for submucosal fibroids — the type most directly responsible for heavy menstrual bleeding — and produces dramatic improvement in bleeding for most patients. It is not appropriate for fibroids located primarily within the uterine wall or on the outer surface of the uterus. Fertility is fully preserved.
Laparoscopic Myomectomy — Minimally Invasive Fibroid Removal
Laparoscopic myomectomy removes intramural and subserosal fibroids through three to four small abdominal incisions using a camera and specialized instruments. The procedure preserves the uterus and fertility, offers the advantages of minimally invasive surgery — smaller incisions, less postoperative pain, reduced blood loss, and faster recovery compared to open surgery — and is appropriate for women with a moderate number of fibroids in accessible locations. Recovery typically involves two to three weeks before return to normal activity, with most patients feeling significantly better within the first week. Hospital stay is typically one night or same-day depending on operative duration and individual factors.
Robotic-Assisted Myomectomy — Advanced Precision for Complex Cases
Robotic-assisted myomectomy uses the da Vinci surgical platform to give Dr. Andrei enhanced three-dimensional visualization, greater instrument articulation, and a wider range of motion than standard laparoscopy allows. These technical advantages are particularly meaningful for complex cases involving multiple fibroids, large fibroids, fibroids in anatomically difficult locations, or cases requiring extensive uterine reconstruction after fibroid removal. The incisions are small and the recovery experience is similar to standard laparoscopic myomectomy. For the right patient, robotic assistance makes a minimally invasive approach feasible when standard laparoscopy would be technically limiting. Dr. Andrei is trained and credentialed in robotic-assisted gynecologic surgery.
Laparoscopic Hysterectomy — Minimally Invasive Complete Resolution
Laparoscopic hysterectomy removes the uterus entirely through small abdominal incisions using a camera and specialized instruments. It is the only surgical treatment that permanently eliminates both fibroids and the possibility of their recurrence, because it removes the tissue in which fibroids develop. It is the appropriate surgical choice for women who have completed childbearing, who have a substantial fibroid burden, who have had inadequate relief from prior myomectomy, or who have determined that uterine preservation is not a priority for them. Recovery is typically two to three weeks before return to normal activity. Hospital stay is usually one to two nights.
Robotic-Assisted Hysterectomy — Precision for Challenging Anatomy
Robotic-assisted hysterectomy applies the same technical advantages of robotic surgery to hysterectomy — enhanced visualization, greater instrument precision, and superior access in anatomically complex cases. It is particularly valuable when the fibroid uterus is large, when anatomy is distorted, or when the surgical field involves structures that benefit from the robotic platform’s three-dimensional imaging and articulated instruments. Recovery is similar to laparoscopic hysterectomy. For appropriate candidates, it offers a minimally invasive option for cases that might otherwise require open abdominal surgery.
The decision between these procedures is made collaboratively during the surgical consultation, based on your specific fibroid characteristics on imaging, your reproductive goals, your anatomy, and Dr. Andrei’s surgical assessment of which approach is most appropriate and technically optimal for your case.
Dr. Ramona D. Andrei, MD, PhD, FACOG is a board-certified gynecologist with advanced training in minimally invasive and robotic-assisted surgery. Her surgical approach prioritizes the least invasive technique that is safe and appropriate for each patient’s anatomy and clinical situation — with a consistent focus on reducing recovery time and surgical impact.
Robotic & Laparoscopic Surgery
Dr. Andrei performs robotic-assisted and laparoscopic myomectomy and hysterectomy, including complex cases involving large or multiple fibroids. Minimally invasive approaches are prioritized whenever they are safe and technically feasible. For cases where standard laparoscopy would be limiting, robotic assistance expands what is achievable without open surgery.
Hospital Affiliations
Surgical procedures are performed at McLaren Lapeer Region, Beaumont Hospital Royal Oak, and Crittenton Hospital — providing access to facilities equipped for the full range of minimally invasive gynecologic surgery. These affiliations serve patients from both the Lapeer and Rochester Hills service areas conveniently.
The Surgical Consultation
The surgical consultation at Lapeer Women’s Health is a thorough, unhurried appointment focused on reviewing your imaging, explaining the surgical options appropriate for your case, discussing risks, benefits, and recovery in detail, and answering every question you have. No surgical recommendation is made without this level of shared understanding.
Knowing what the surgical experience actually involves — from the preoperative period through recovery — is an important part of making an informed decision. The following overview reflects the typical experience for minimally invasive fibroid surgery at Lapeer Women’s Health.
The Surgical Consultation
The consultation appointment involves a thorough review of your imaging, a detailed discussion of the surgical options appropriate for your case, an explanation of risks and benefits specific to the recommended procedure, and a full opportunity to ask questions. There is no pressure toward a particular decision. The goal of the consultation is to ensure that if you proceed with surgery, you do so with complete and accurate information about what will happen, what the recovery involves, and what the expected outcomes are.
Preoperative Preparation
Preoperative preparation for fibroid surgery typically includes updated imaging if recent ultrasound is not available, preoperative laboratory work, and in some cases a short course of GnRH agonist therapy to shrink fibroids before surgery and improve anemia. The specific preoperative plan is individualized based on the procedure planned, the patient’s current health status, and any factors that warrant optimization before the scheduled date.
The Day of Surgery
Minimally invasive fibroid surgery is performed under general anesthesia at one of Dr. Andrei’s affiliated hospital facilities. The operative duration varies depending on the procedure and the complexity of the individual case — typically ranging from one to three hours for most laparoscopic and robotic-assisted myomectomies and hysterectomies. Hospital stay after minimally invasive surgery is typically one night for most procedures, with same-day discharge for simpler cases such as hysteroscopic myomectomy.
Recovery After Minimally Invasive Fibroid Surgery
Most patients undergoing laparoscopic or robotic-assisted fibroid surgery are mobile within hours of surgery and feel meaningfully better within the first week. Return to light activity typically occurs within one to two weeks. Full return to normal activities including exercise is typically achieved within two to four weeks for most minimally invasive procedures. Hysteroscopic myomectomy, which involves no abdominal incisions, generally allows return to normal activities within a few days. Open abdominal surgery, when required, carries a longer recovery of four to six weeks — which is one of the primary reasons minimally invasive approaches are prioritized whenever they are technically feasible.
Symptom Improvement After Surgery
Heavy menstrual bleeding typically improves dramatically within the first one to two menstrual cycles after myomectomy or hysterectomy. Pelvic pressure, bladder symptoms, and abdominal distension typically improve as the structural fibroid mass is removed and surrounding organs decompress over the weeks following surgery. Anemia, when present preoperatively, resolves over weeks to months as the body rebuilds its iron stores in the absence of ongoing blood loss. Most patients report that the improvement in their quality of life following surgery significantly exceeded their expectations — in part because they had adapted to their symptoms so gradually that they had forgotten what baseline felt like before fibroids.
Many women arrive at a fibroid surgical consultation having already spent considerable time living with symptoms they were told were manageable, being offered only hysterectomy when uterus-preserving options were available, or given the impression that their fibroids were not yet serious enough to operate on. Sometimes those assessments were correct. Sometimes they were not.
The surgical consultation at Lapeer Women’s Health is designed to give you a complete and honest picture of where surgery fits in your specific situation — whether that means confirming that surgical intervention is appropriate and timely, identifying a minimally invasive option that was not previously offered, or supporting a decision to pursue further medical management before committing to surgery. The goal is not to operate. The goal is to make sure you have the information to decide for yourself.
Dr. Ramona D. Andrei and the team at Lapeer Women’s Health are here for that conversation — at both our Lapeer and Rochester Hills offices, without a referral required.
Fibroid Surgery
Whether you are considering surgery for the first time, seeking a second opinion, or ready to schedule a procedure, Dr. Andrei and the team at Lapeer Women’s Health are here — at both our Lapeer and Rochester Hills offices, without a referral required.
Schedule a Gynecologic VisitThe information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and surgical recommendations vary significantly. Reading this content does not establish a physician-patient relationship with Dr. Ramona D. Andrei or Lapeer Women’s Health. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Please consult a qualified healthcare provider for advice specific to your situation. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.