Surgery for heavy periods: What can help?

Surgery to remove the lining of the womb (endometrial resection or ablation) isn't always as effective as surgery to remove the womb (hysterectomy) over the long term. The procedure has fewer side effects, though. Neither approach is suitable for women who still want to have a baby.

Heavy periods (menorrhagia) can be a real problem. Because it's usually successful, surgery is sometimes seen as a permanent solution – at least for women who don’t want to have any (more) children. But all surgical procedures are associated with risks, so it’s important to carefully consider the options.

Heavy periods are not an emergency. There is enough time to weigh the pros and cons of the different types of surgery, as well as other options such as treatment with hormones.

Removal of fibroids or polyps

Heavy periods are often caused by growths in or on the womb, such as fibroids or polyps. They can be surgically removed through the vagina or the abdominal cavity. It is usually still possible for women to get pregnant afterwards.

If heavy periods are caused by something else, or if they're so bad that they greatly affect your everyday life, two other treatments can be considered:

Removal of the lining of the womb

The destruction or removal of the lining of the womb (endometrium) is called endometrial ablation or endometrial resection. Women’s periods often stop or become a lot lighter after this type of surgery. Sometimes the lining of the womb grows back, though. If that happens, the procedure can be repeated.

There may be menstruation-like bleeding and pain for one to two weeks after this surgery. Women may also have a discharge for several weeks. They are usually no longer able to get pregnant.

Removal of the womb (hysterectomy)

The surgical removal of the womb is a more major operation. As well as the risks associated with surgery and the possible physical consequences such as pain during sex, it may affect women emotionally too.

The womb can be removed through a cut across the abdomen (open abdominal surgery), small cuts in the abdomen (laparoscopy), or through the vagina. The last two approaches aren't possible for all women due to medical reasons. Another approach uses additional laparoscopy to help guide vaginal hysterectomy.

Hysterectomies may remove all or part of the womb. If it is partially removed, only the main body of the womb is taken out, and the cervix remains in place. Because the cervix is covered in the same mucous lining, women may still have light periods after this operation.

Comparing the two types of surgery

Researchers from the Cochrane Collaboration (an international network of researchers) looked for studies that compared the advantages and disadvantages of these two surgical approaches. They found nine studies involving a total of about 1,300 women.

In four studies with nearly 650 participants, the women were asked about the success of their treatment one year after having it. These women had either had an endometrial resection or hysterectomy. 89 out of 100 women who had an endometrial resection said that their periods had become lighter. All of the women who had a complete hysterectomy no longer had periods.

What are the risks and disadvantages of these procedures?

The women who had a hysterectomy experienced more complications than those who had only the lining of their womb removed: In four studies involving a total of 620 participants,

32 out of 100 women who had a hysterectomy had infections, fever, or needed a blood transfusion afterwards,
compared to only 6 out of 100 women who had surgery to remove the lining of their womb.

Most of these complications were temporary, though, and didn't have any long-lasting effects.

Women who only had the lining of their womb removed were also able to return to everyday activities much sooner than those who had a hysterectomy. But 20 out of 100 women who had the lining of their womb removed needed further surgery within two years.

How satisfied were the women with the outcomes of their surgery?

Almost 500 women in four studies were asked about their quality of life two years after they had surgery. The outcome: Compared with the women who had the lining of their womb surgically removed, more women who had a hysterectomy said that their health had improved and that they had less pain than before. But women who had a hysterectomy also had more emotional problems afterwards.

Two years after the surgery, nearly 570 women were asked whether they were pleased with their treatment overall. Most of them said they were: Regardless of which of the two treatments they had, about 75 out of 100 women were satisfied with the result.

Fergusson RJ, Lethaby A, Shepperd S, Farquhar C. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Cochrane Database Syst Rev 2019; (8): CD000329.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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