The paper summarizes the results of long-term research and clinical activities of the employees of the Moscow Regional Research Institute of Obstetrics and Gynecology to preserve reproductive function in patients with uterine myoma. It presents management tactics for reproductive-aged women with uterine myoma in pregnancy and non-pregnancy and reflects indications for myomectomy, the specific features of preoperative preparation, anesthetic aid, and myomectomy techniques in both non-pregnant and pregnant women. Particular emphasis is placed on the fact that it is necessary to create favorable conditions for repairing tissues, preventing pyoseptic complications, making an adequate uterine scar, eliminating threatened miscarriage, improving uteroplacental blood flow in the early postoperative period, and performing further complex postoperative rehabilitation involving gonadotropin-releasing hormone agonists, which enables reproductive-aged women to preserve fecundity.