Abstract Abdominal myomectomy is the commonest conservative surgical procedure offered to patients with symptomatic fibroids and as a fertility enhancing procedure to some women with large intramural fibroids when no other cause for subfertility is evident. Historically myomectomy has been considered to be a complex procedure with high risk of complications. However, there is no evidence to support this assumption and recent studies have shown that the morbidity of myomectomy and hysterectomy is comparable. In recent times, new treatment strategies with a minimally invasive approach have evolved but are available only in selected centres and their efficacy has not been evaluated in the light of well-designed research trials. Therefore, myomectomy remains the mainstay of surgical treatment in women who wish to retain their uterus. This review aims to dispel the misconceptions about morbidity of myomectomy and provides an evidence-based account of the measures that can be taken to minimise it.