Hysterectomy for Heavy Menstrual Bleeding (Menorrhagia)

Hysterectomy for heavy menstrual bleeding at a glance

Heavy menstrual bleeding (formerly known to the medical community as menorrhagia) and painful periods (dysmenorrhea) can be the result of a number of conditions including endometriosis and uterine fibroids.
Heavy menstrual bleeding is a common disorder women report to their physicians, experienced by approximately 1 in 5 women, according to the Centers for Disease Control and Prevention.
Hysterectomy, the surgical removal of a woman’s uterus, can be an effective treatment of heavy bleeding but it does render the woman unable to have more children.
Heavy menstrual bleeding and the conditions that cause it are treated with hysterectomy when other medical treatments have failed.

What is hysterectomy?

Hysterectomy is a surgical procedure that removes a woman’s uterus. During a hysterectomy the surgeon may also remove other reproductive organs such as the ovaries or fallopian tubes, depending on the condition the hysterectomy is meant to treat.

In women who have yet to reach menopause, the removal of the uterus will stop monthly periods, eliminating heavy bleeding. This also makes future pregnancy impossible.

A hysterectomy can be performed as an open surgery or as a minimally invasive procedure.

What is heavy menstrual bleeding?

Abnormal bleeding refers to excessive bleeding or clotting, periods that last longer than seven days, or bleeding in between periods, after sex or after menopause.

While many women experience heavy periods, not all women experience bleeding that requires a medical intervention. A good sign that heavy bleeding is excessive is if it keeps a woman from doing her normal activities when having her period. The cramps and blood loss can be debilitating, disrupting the woman’s day-to-day routine including missing work and personal enjoyments.

There are a number of causes for heavy uterine bleeding. One cause is natural hormone changes. Women approaching menopause are likely to experience abnormal bleeding due to hormone changes, as are teens, most often due to anovulation and during their first year of menstruation. Other potential causes of heavy bleeding and menorrhagia include:

Some birth control methods.
Some bleeding/clotting disorders.
Thickening of the endometrial lining, known as hyperplasia.
Endometriosis.
Uterine fibroids or polyps.
Uterine or cervical cancer.
Certain bleeding disorders that are inherited, and other medical conditions including those of the kidneys and liver.
Problems related to pregnancy, such as ectopic pregnancy and miscarriage.
Some medications.

If bleeding soaks through one tampon or pad in an hour for two hours or more, a woman should see her doctor. This is also the case if she bleeds between periods or has unusual vaginal bleeding, including if after menopause. Other symptoms that can often indicate heavy menstrual bleeding include the following:

Blood clots about an inch in diameter.
Bleeding for more than 7 days.
Requiring double pads or adult diapers to keep up with the blood flow.
Anemia or fatigue.

We often diagnose heavy menstrual bleeding with a medical history and physical exam. In certain cases, or where a particular condition is suspected, a doctor may perform a transvaginal ultrasound, saline infusion sonogram, MRI or hysteroscopy to reach a diagnosis.

Hysterectomy as a treatment for heavy menstrual bleeding

We can often treat heavy menstrual bleeding at the menorrhagia level. Before we consider hysterectomy as the treatment, which removes the uterus and makes pregnancy impossible, we make sure to consider or try other options.

Common treatments for heavy bleeding include birth control pills, progesterone treatments, intrauterine devices (IUD), and myomectomy (surgical removal of uterine fibroids). These treatments may often precede procedures that would prevent a woman from becoming pregnant, such as endometrial ablation (the surgical elimination of the uterine lining) and hysterectomy.

Hysterectomy can effectively eliminate heavy bleeding in cases where other treatments haven’t worked or bleeding has a significant impact on a woman’s life. Women of reproductive age must carefully weigh the benefits of hysterectomy with their desire to have children.