Surgical Treatment for Regular Heavy Bleeding

In my last blog, I discussed medical treatment options for regular heavy periods.  Now, I will discuss surgical options.  Typically, but not always, we like to try medical options first.  Most medications have the potential for side effects, but surgery always has its own inherent risks.

The most important thing to know about surgical treatment for regular heavy periods is that some options will permanently take away the ability to carry a child in the uterus (especially the last option, a hysterectomy, because there will be no more uterus).

If the cause of the uterine bleeding is a polyp, we can easily remove it in the operating room using the hysteroscope.  The hysteroscope is a device we can put inside the uterus and actually see what is going on.  Some hysteroscopes have an operative port through which scissors can be passed to remove the polyp at it’s base while actually watching this occur.  Other times, we see the polyp with the hysteroscope and then use polyp forceps to remove the polyp from the uterus.  These are similar to large graspers that we put inside the uterus to grab the polyp.

If the cause of the bleeding is a fibroid, the mechanism by which we remove it is based on where the fibroid is located.  We can potentially get some fibroids out similarly to a polyp if they are on the inside of the uterus.  These are called submucosal fibroids.  But if a fibroid is in the muscle of the uterus (intramural) or on the outside of the uterus (submucosal), we need to enter the abdominal cavity to remove the fibroid.  There are other treatment options for fibroids, but I will not discuss those in today’s blog.  Fibroids deserve a blog of their own!

Today, a very common yet minimally invasive treatment for heavy bleeding is endometrial ablation.  This means that we destroy the endometrium (the lining of the uterus) to the deep layer so that it is unable to regenerate.  There are several techniques to destroy the endometrium, but our practice mainly uses Novasure and Thermachoice.  Novasure uses electrocautery to burn the lining and Thermachoice uses a very hot water-filled balloon to burn the lining.

Finally, the most definitive treatment option for heavy bleeding is a hysterectomy. Remember, a hysterectomy is removing the uterus.  It does not necessarily mean we remove the ovaries.  The ovaries are what provide a woman with her hormones.  We can do a vaginal hysterectomy, an abdominal hysterectomy, a laparoscopic hysterectomy (leaving or removing the cervix), or a robotic hysterectomy.  A hysterectomy typically requires the longest recovery of any of the options I discussed in today’s blog.

I want to just touch on a D&C (dilatation and curettage).  A D&C is essentially scraping the lining of the uterus down to the deep layer.  Although it sounds like a great fix, we are not really treating anything.  If a woman is cycling regularly, the lining will just grow back the next month.  So although a D&C is a great way to obtain tissue for diagnosis, it is not really meant for treatment.