Heavy, or abnormal, menstrual bleeding is incredibly common, affecting one out of every five menstruators in the U.S. It can happen at any point in a person’s life, and make normal living extremely difficult. Trips planned out of the house may cause anxiety, long shifts at work may be marked by frequent bathroom breaks to check on bleeding and trying to stay active may be downright uncomfortable or even painful.

While medication can be a highly effective treatment option for some, doctors may determine surgery is necessary to control heavy menstrual bleeding if you’ve tried medication without success, or if a structural abnormality is the cause of your abnormal bleeding.

Thankfully, many of the surgical techniques gynecologists use to treat abnormal menstrual bleeding today are minimally invasive, can be performed in your surgeon’s office or in a hospital and result in a quick recovery and return to daily activities.

What are the surgical options for treating heavy menstrual bleeding?

If you and your provider determine that surgical treatment for heavy menstrual bleeding is the path forward, you will also discuss the various options to see which is best for your cause, symptoms and lifestyle. With all of them, you and your provider will assess the risks and benefits of surgical treatment for your heavy menstrual bleeding.

Endometrial ablation

If you have a normally shaped uterus (specifically, the inside cavity of the uterus) and no particular reason can be found for your abnormal bleeding, then your provider may suggest an endometrial ablation. An ablation works by destroying the lining of the uterus (called the endometrium), which results in decreased bleeding.

Most endometrial ablations can be performed as office surgery if you have no major medical problems, a relatively normal-sized uterus and do not need a general anesthetic. Otherwise, endometrial ablations can be performed in the operating room. Endometrial ablation provides an option for controlling abnormal bleeding without the need for a hysterectomy.

Important: If you may want to become pregnant in the future, an endometrial ablation is not an option for you. It is also quite important to make sure you have a reliable form of contraception (birth control) before having an endometrial ablation because if you become pregnant after having one, there could be significant complications, and you should alert your provider as soon as possible.

What is the recovery process after surgery?

An endometrial ablation has a quick recovery time with most patients going home the same day and returning to normal daily activities within one to two days. Very few, if any, report any significant side effects.

How effective is surgical intervention for heavy periods?

The procedure is less effective in younger people or those with fibroids (which can distort the uterine cavity), but endometrial ablations ultimately control heavy bleeding around 90% of the time. The success rate usually breaks down as follows:

  • one-third of patients will stop having periods
  • one-third will have decreased or light periods
  • one-third will go back to having a normal period after an endometrial ablation

Hysteroscopy (hysteroscopy polypectomy and hysteroscopy myomectomy)

If polyps or fibroids are causing abnormal menstrual bleeding, a hysteroscopy may be performed. An operative hysteroscopy is a minimally invasive procedure that involves inserting a thin, lighted tube into the uterus to remove the polyps (hysteroscopy polypectomy) or fibroids (hysteroscopy myomectomy). This procedure can be done in a hospital or your surgeon’s office with local, regional or general anesthesia and typically lasts up to an hour.

Important: Note that you cannot undergo a hysteroscopy if you’re pregnant or have a pelvic infection. You can still get pregnant after a hysteroscopy since it does not disrupt the uterine lining or blood supply. It can help improve fertility depending on the size and placement of the polyps or fibroids.

What is the recovery process after surgery?

A hysteroscopy is more of a minor surgery, and most patients are sent home the same day. Patients may feel cramping or light bleeding for a few days and should avoid inserting anything in the vagina (like a tampon or having penetrative intercourse) for at least two weeks.

How effective is it?

Polypectomy and myomectomy are very effective at stopping abnormal menstrual bleeding caused by intracavitary polyps and fibroids. It’s important to know that both polyps and fibroids can return, which is more common the younger you are.

Uterine embolization

If fibroids are the cause of heavy menstrual bleeding, uterine embolization (aka, uterine fibroid surgery) may be performed. A uterine embolization is a procedure where small particles are injected into the uterine arteries to block blood flow, reducing the size of fibroids and consequently heavy menstrual bleeding caused by them.

Good candidates for uterine embolization are those with large fibroids that are not located within the uterine cavity who want a less invasive surgical option.

Important: This procedure is not a viable option for those considering childbirth in the future.

What is the recovery process after surgery?

A uterine embolization blocks the blood flow to the fibroids causing them to shrink over the course of weeks and months. There is often severe pain as the fibroids degenerate.

How effective is it?

The success rate of uterine fibroid embolization at alleviating fibroid-related symptoms like heavy bleeding is 85%. After the procedure, fibroids are reduced in size by 42-83%, though they can grow back.


The most major and absolute surgical option to stop abnormal bleeding is a hysterectomy—a surgical procedure that removes the uterus and usually your cervix. Hysterectomies can be performed vaginally, abdominally or laparoscopically, and the decision on the surgical approach is made collaboratively with your surgeon based on your specific circumstances.

What is the recovery process after surgery?

Recovery times from a hysterectomy vary depending on the surgical approach.

With vaginal and laparoscopic surgeries, about 85% of patients can go home the same day—and nearly all others go home the next day. Recovery from these less invasive approaches takes about four to six weeks. The hospital stay for an abdominal surgery varies, but most are two to three days and recovery takes up to six to eight weeks.

How effective is it?

A hysterectomy is 100% effective at stopping all menstrual bleeding, including abnormal bleeding–but also means pregnancy is no longer an option.

At WHA, our OB/GYN physicians are also surgeons experienced in many surgical techniques and approaches. If you’re experiencing abnormal menstrual bleeding, contact one of our offices to make an appointment.