Uterine leiomyomas are the most common benign tumors in women of reproductive age. Most of leiomyomas are asymptomatic. They are often found incidentally, and require neither monitoring nor treatment. For symptomatic women who wish to become pregnant, surgical myomectomy remains the conservative treatment of choice. It can be performed in various routes depending on the location and the number of leiomyomas and the experience of the surgeon. A minimally invasive procedure should always be the preferred option so as to improve woman satisfaction and to decrease perioperative morbidity. In selected patients, medical therapy prior to surgery can be useful to correct anemia, to improve the quality of life and to decrease the volume of the leiomyomas. The use of blood saving techniques need to be mastered to prevent or to treat perioperative haemorrhage. Patients must be aware of uterine rupture in case of subsequent pregnancy, even if the risk seems to be very low. Future research challenges include the development of three-dimensional models and augmented reality that could be able to specifically treat leiomyomas without damaging the unaffected part of the uterus.