Surgery is only recommended in rare cases where amenorrhea is linked to:
There are several surgical options available for women with heavy menstrual bleeding. You should carefully consider your surgical options since some may affect your ability to have children.
D&C is the standard procedure to remove the lining of the uterus and allow replacement by healthier cells. The cervix is dilated and a scoop-shaped instrument, called a curette, is inserted and used to scrape the uterine lining and remove tissue through the vagina.
In the past, the D&C was purported to be both a diagnostic and a therapeutic procedure. Currently, the D&C is no longer viewed as an effective therapy for menorrhagia. This procedure will not help menorrhagia due to adenomysosis (a condition in which endometrial cells move into the muscle of the uterus).
Using an instrument called a hysteroscope (a long, thin telescope with a camera on the end), the doctor is able to visualize the interior of the uterus and to remove the cause of bleeding, such as a polyp or a fibroid. This procedure is often done in combination with an ablation or a resection of the uterine lining.
In an endometrial ablation, the lining of your uterus (the endometrium) is destroyed. This procedure is highly effective in eliminating heavy bleeding.
There are several ways to perform an endometrial ablation. One way uses lasers or electric voltage to destroy the endometrium. The uterus is filled with fluid to help the doctor have a better view. A laser beam or high electric voltage is usually used to vaporize the uterine tissue. Another technique uses a device that applies heat as it rolls across the uterine lining, destroying the endometrial tissue. In microwave ablation, microwaves are generated inside the uterus to heat and destroy the lining of the uterus. Another way to perform an endometrial ablation is by using a balloon. Here, the lining of your uterus is destroyed by placing a balloon filled with hot fluid inside the uterus.
In an endometrial resection, the lining of your uterus is removed. This procedure is highly effective in eliminating heavy bleeding. The cervix is dilated and fluid is pumped into the uterine cavity to help the doctor have a better view of the uterus. The lining is then removed with an electrosurgical wire loop.
These procedures will not help menorrhagia due to adenomyosis.
Hysterectomy is the surgical removal of the uterus. The most common reason for hysterectomy is heavy bleeding, but this surgery is only done for the most severe cases. In some cases, the ovaries are removed, as well, in a procedure called oophorectomy. Oophorectomy is usually performed only after age 40-45 years, as the woman approaches menopause. The ovaries are removed to prevent later development of ovarian cancer. This surgery leads to premature menopause in younger women.
Abnormal uterine bleeding. FamilyDoctor.org website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/abnormal-uterine-bleeding.html. Updated August 2010. Accessed August 20, 2012.
Amenorrhea. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 21, 2011. Accessed August 20, 2012.
Amenorrhea. FamilyDoctor.org website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/amenorrhea.html. Updated August 2010. Accessed August 20, 2012.
Heavy menstrual bleeding. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated 25, 2012. Accessed August 20, 2012.
Last reviewed September 2013 by Andrea Chisholm, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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