Treating with surgery

If you have tried medication treatments for your heavy periods with no improvement, surgery may be your next option.

You may consider surgery if you:

• tried medication but it didn’t help
• could not try medication because of other health issues
• have fibroids
• have other conditions which cause bleeding and pain (e.g. endometriosis).

Surgery aims to stop bleeding and pain completely by removing or reducing the cause (fibroids, polyps, or the lining of the uterus) or by removing the uterus completely.

There are three main operations used to treat heavy menstrual bleeding.

Endometrial ablation removes or destroys the lining of your uterus using heat or microwaves. A long, narrow instrument called a hysteroscope is put inside your uterus (through your vagina) to allow the doctor to see and to perform the ablation. This can be done under local or general anaesthetic.

Myomectomy removes fibroids from your uterus. Sometimes this involves one long cut across your belly (abdominal myomectomy) or several small cuts across your belly (laparoscopic or ‘keyhole’ myomectomy). Sometimes it is done using a hysteroscope and so there are no cuts at all (hysteroscopic myomectomy). This is done under general anaesthetic

Hysterectomy removes your entire uterus and sometimes your cervix, ovaries, and fallopian tubes. This can be done with one cut (abdominal hysterectomy), several small cuts (laparoscopic or ‘keyhole’ hysterectomy) or without any cuts (vaginal hysterectomy).

You and your doctor or surgeon will discuss the best course of action for you. Write down any questions or concerns about your possible treatment and discuss them and your options with your doctor.

Treatment options

	Benefits	Disadvantages
Endometrial ablation	Safest surgical treatment Usually only in hospital for one day Significantly reduces heavy bleeding (around 85 percent of women have improvement and around 35 percent have no further bleeding) Can also be used to remove some fibroids and polyps	For some women heavy bleeding returns May not reduce period pain There are major complications in about 1 in 1000 procedures. These can include infection, damage to the bowel or a hole in the uterus It may be difficult to investigate any future problems in the uterus
Myomectomy	Reduces heavy bleeding The best surgical option for women who want to be able to have (more) children May improve other symptoms caused by fibroids such as feelings of pressure	There is a small risk that an emergency hysterectomy will need to be done There is also a risk of excessive bleeding requiring a blood transfusion Fibroids can regrow
Hysterectomy	The only guaranteed way to stop menstrual bleeding completely May reduce period pain Most women are very satisfied with it Reduces the risk of uterine and ovarian cancer (even when your ovaries are not removed)	Is a major surgical procedure with potential complications Recovery takes 2-6 weeks depending on the type of hysterectomy You will no longer be able to have children May lead to early menopause (even if your ovaries are not removed) May increase the risk that your bladder or bowel move down into your vagina (vaginal prolapse)

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