Do you feel as though your periods impact your quality of life?
Does your bleeding soak through one or more pads or tampons every hour for several hours?
If you answered yes to either of these questions, here are possible options:
The simplest method for controlling heavy bleeding is oral contraception or progesterone. The problem, however, is that many woman cannot take hormones due to side effects, medical issues or fear of hormone usage.
Another option is the use of an intrauterine device called “Mirena®”, This device is inserted into the uterus to provide contraception and/or control heavy bleeding. It is T-shaped device placed in the uterine cavity during an office visit. The Mirena® releases progesterone locally, although a very minimal amount does enter the bloodstream and can potentially cause hormonal side effects. The local concentration of hormone is what controls bleeding. It is very safe and approximately 80% of women who wish to become pregnant do so within 12 months after removal.
Endometrial ablation is a procedure that can be performed either in the office or in the operating room. Both are performed in the same manner. The procedure involves applying heat to the uterine lining which destroys most of the tissue responsible for creating a menstrual cycle. Each month during a period, the uterine lining is shed and a new lining develops. By preventing re-growth of this lining, the ablation procedure can stop periods permanently.
Prior to ablation, the lining of the uterus needs to be evaluated by visualization using a hysteroscope inserted through the cervix and an endometrial biopsy (tissue sample). After the ablation procedure, 90% of patients are satisfied with the results. One year after the ablation, 37% of patients experience no menses and 89% experience a reduction in pain. 81% have normal levels of bleeding or less. Approximately 10% of patients will fail the ablation procedure. If this happens, it is generally recommended the procedure not be repeated. Other options include going back to hormonal management or hysterectomy.
May download Post Operative Instructions after Ablation
A complete hysterectomy is removal of the uterus and cervix but not necessarily removal of the ovaries. A “partial” hysterectomy or supracervical hysterectomy removes the body of the uterus and leaves the cervix. A hysterectomy with bilateral salpingo-oophorectomy means removing the entire uterus, cervix and ovaries. Keeping the ovaries preserves hormonal function, protects bones and prevents menopausal symptoms. Some studies show keeping the ovaries can also lower your risk of heart disease. Removing the ovaries lowers the risk of ovarian cancer, endometriosis or future surgeries. These options can be discussed at the time of your visit.
In order to stop bleeding, only the uterus and cervix or just the uterine body needs to be removed. The ovaries can often be preserved. The route of removal can be laparoscopic, abdominal or vaginal. Most can be performed through minimally invasive laparoscopic surgery or through the vagina. The minimally invasive approaches allow for quicker recovery time and a shorter hospital stay.