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Surgical treatment options for Heavy Menstrual Bleeding

Many women with long standing heavy periods will be started on medications as detailed in the options above. Depending on the individual’s circumstances, that may be all she requires. However, in some cases, the woman in question may not wish to try the medication options or the Mirena IUS. In other cases those options may not work or could be simply unsuitable for her. In such situations, there are effective surgical options to consider.

Endometrial ablation: These are procedures where the lining of the womb is removed usually using devices which deliver heat energy to burn it away. There are numerous ablation methods all of which have the same end result: The destruction and removal of the lining of the womb. Endometrial ablation is a very effective way of dealing with heavy periods. Long term satisfaction rates are consistently in the 80-90% range.

     Most endometrial ablation procedures can be carried out in the outpatient setting with a local anaesthetic and standard pain-killers only. However, depending on facilities and expertise, this outpatient/office setting option may be unavailable in some places and the procedure may have to be done in Theatre with a short general anaesthetic. A woman undergoing endometrial ablation can expect instant benefits. There is usually a period of two or three weeks immediately after the procedure where she will experience a vaginal discharge as the debris from the destroyed lining is shed. After that, there is usually no periods for a couple of months. When the periods come back, they are usually very light and short, typically lasting no more than a couple of days in every cycle.

    In 30-40% of those receiving the treatment, periods disappear altogether.  Endometrial ablation is absolutely contra-indicated in anybody who might want to have children in the future. It is therefore rarely an option for young women in their twenties who may be suffering from heavy periods. Since most women with this problem will be in their late 30s onwards and most would have completed their families, this tends not to be an issue. However, for doctors, it is imperative that this aspect of the treatment is thoroughly discussed and understood. This is regardless of a woman’s age. At the bottom of the page a couple of video animations have been added to demonstrate ‘thermal balloon ablation’ and ‘Novasure ablation’, two of the most popular ablation methods available.

Myomectomy: Myomectomy is the name for the surgical procedure to remove fibroids (myoma). If a woman is found to have fibroids that are deemed significant, she can have myomectomy performed as a way of relieving the problem. Fibroids inside the womb cavity (sub-mucosal) can be resected via the vaginal route. However, fibroids that are within the wall of the uterus will require an abdominal approach. Traditionally, this has been performed through an open procedure. Increasingly, myomectomy is performed via the minimal access (laparoscopic) approach. Where the necessary surgical expertise is available, this tends to be the preferred route as recovery from surgery is a lot quicker and hospital stay is dramatically shortened, rarely lasting more than 24 hours. Myomectomy is an especially attractive option for a woman who is suffering from heavy periods but who is keen to preserve her fertility.

Hysterectomy: Hysterectomy is the surgical removal of the uterus. This is, of course, guaranteed to cure the problem of heavy periods (menorrhagia). However, it is a major operation and, in modern practise, it is regarded as an option of last resort. It is rarely, if ever, justified to offer a hysterectomy as a first option in a case of menorrhagia in the presence of much less radical options which are quite effective. A hysterectomy has a potential for major complications, some of them irreversible and should be reserved for where other methods (above) are either unavailable, unsuitable or have failed.