What types of surgery are effective for heavy periods?
Surgical removal of the womb (hysterectomy) is a more effective treatment for heavy periods over the long term than removing the lining of the womb (endometrial resection or endometrial ablation). Removing the lining of the womb causes fewer side effects, but the procedure may have to be repeated.
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 consider the options carefully.
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 treatment options.
Surgical 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. Afterwards it is usually still possible for women to get pregnant.
Two other treatment options are considered if the heavy periods are caused by something else, or are so bad that they significantly affect the woman’s everyday life:
Surgical 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.
Surgical removal of the womb (hysterectomy)
Hysterectomy (surgical removal of the womb) is a more major operation. As well as the risks associated with surgery and the possible physical consequences, it may affect women emotionally too.
The womb can be removed using open abdominal surgery, laparoscopy, or through the vagina. Due to medical reasons, though, the last two options aren’t always possible for every woman. One approach involves removing the womb through the vagina while at the same time using laparoscopy to monitor the operation.
The womb can either be completely or partially removed. If it is partially removed, only the main body of the womb (corpus uteri) 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 hysterectomy and removal of the endometrium
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 eight 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 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 their endometrium 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 their endometrium.
Most of these complications were temporary, though, and didn't have any long-lasting effects.
Women who only had their endometrium 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 their endometrium removed had the same procedure again within two years.
How satisfied were the women with the outcomes of their surgery?
In four studies almost 500 women were asked about their quality of life two years after they had surgery. The result: Compared with the women who had their endometrium 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 2013; (11): CD000329.
IQWiG health information is written with the aim of helping
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