Procedures and surgery
When medication is not enough or is not the right fit, procedures can remove the source of bleeding or the lining itself. The options depend on the cause and on whether you want a future pregnancy.
| Procedure | What it treats | Keeps the uterus | Future pregnancy |
|---|---|---|---|
| Hysteroscopic polypectomy | Polyps | Yes | Yes |
| Hysteroscopic myomectomy | Fibroids inside the cavity | Yes | Yes |
| Laparoscopic, robotic, or open myomectomy | Fibroids in or on the wall | Yes | Yes, with planning |
| Uterine artery embolization | Fibroids | Yes | Generally not advised |
| Radiofrequency ablation of fibroids | Fibroids | Yes | Data limited |
| Endometrial ablation | Heavy bleeding from the lining | Yes | No; contraception required |
| Hysterectomy | All uterine causes | No | No |
Myomectomy
Removes fibroids and preserves the uterus. It is the usual choice for people with fibroids who want a future pregnancy. Fibroids can grow back over time.
Uterine artery embolization
An interventional radiologist blocks the blood supply to fibroids through a small catheter, usually placed at the wrist or groin. Fibroids shrink and bleeding improves for most patients. It is typically done with an overnight stay or less.
Endometrial ablation
Destroys the uterine lining in an outpatient procedure and reduces or stops bleeding for many people. It is only for people who have finished childbearing. A pregnancy after ablation is dangerous, so reliable contraception is still needed. Cancer and precancer must be ruled out first. Some people eventually need a hysterectomy.
Hysterectomy
Removal of the uterus. It permanently ends periods and the ability to carry a pregnancy. When possible, it is done through minimally invasive approaches, vaginal, laparoscopic, or robotic, which allow faster recovery. The ovaries can often be kept, which avoids surgical menopause.
Sources
- American College of Obstetricians and Gynecologists. Practice Bulletin No. 228: Management of symptomatic uterine leiomyomas. Obstet Gynecol. 2021;137(6):e100–e115.
- American College of Obstetricians and Gynecologists. Practice Bulletin No. 81: Endometrial ablation. Obstet Gynecol. 2007;109(5):1233–1248 (reaffirmed).
- AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps. J Minim Invasive Gynecol. 2012;19(1):3–10.