Menstrual Disorders - Surgery

Surgery

Women with heavy menstrual bleeding, dysmenorrhea, or both have surgical options available to them. Most procedures eliminate or significantly affect the possibility for childbearing, however. Hysterectomy removes the entire uterus while endometrial ablation destroys the uterine lining.

For some women, an intrauterine device (IUD) that releases progestin is proving to be a good medical alternative to surgery. The levonorgestrel-releasing intrauterine system, or LNG-IUS (Mirena), is increasingly being used instead of surgery to treat heavy menstrual bleeding. Studies have found the LNG-IUS to work just as well as ablation. Women should be sure to ask their doctors about all medical options before undergoing surgical procedures.

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Endometrial Ablation

In endometrial ablation, the entire lining of the uterus (the endometrium) is removed or destroyed. For most women, this procedure stops the monthly menstrual flow. In some women, menstrual flow is not stopped but is significantly reduced.

Candidates. Endometrial ablation is not appropriate for women who:

• Have gone through menopause
• Have recently been pregnant
• Would like to have children in the future
• Have certain gynecologic conditions such as cancer of the uterus, endometrial hyperplasia, uterine infection, or an endometrium that is too thin

Considerations. Endometrial ablation significantly decreases the likelihood a woman will become pregnant. However, pregnancy can still occur and this procedure increases the risks of complications, including miscarriage. Women who have this procedure must be committed to not becoming pregnant and to using birth control. Sterilization after ablation is another option.

A main concern of endometrial ablation is that it may delay or make it more difficult to diagnose uterine cancer in the future. (Postmenopausal bleeding or irregular vaginal bleeding can be warning signs of uterine cancer.) Women who have endometrial ablation still have a uterus and cervix, and should continue to have regular Pap smears and pelvic exams.