Surgical Procedures for Menstrual Disorders
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Surgical Procedures for Amenorrhea (Lack of Menstruation)
Surgery is only recommended in rare cases where amenorrhea is linked to ovarian cysts, vaginal blockage, or uterine physical abnormalities.
Surgical Procedures for Menorrhagia (Heavy Bleeding)
There are several surgical options available for women with heavy menstrual bleeding. You should carefully consider your surgical options since some may affect your ability to have children.
Surgical options include:
Surgical Procedures for the Treatment of Menorrhagia
This is the standard procedure to remove the lining of the uterus and allow replacement by healthier cells.
The cervix is dilated and a scoop-shaped instrument, called a curette, is inserted and used to scrape the uterine lining and remove tissue through the vagina.
In the past, the D&C was purported to be both a diagnostic and a therapeutic procedure. Currently, the D&C is no longer viewed as an effective therapy for menorrhagia. This procedure will not help menorrhagia due to adenomysosis.
Using an instrument called a hysteroscope, the surgeon is able to visualize the interior of the uterus and to remove the cause of bleeding, such a polyp or a submucous fibroid. This procedure is often done in combination with an ablation or a resection. A hysteroscopy will not help menorrhagia due to adenomysosis.
Endometrial Ablation (and Resection)
In an endometrial ablation, the lining of your uterus (the endometrium) is destroyed. This procedure is highly effective in eliminating heavy bleeding.
There are several ways to perform an endometrial ablation. One way uses lasers or electric voltage to destroy the endometrium. The uterus is filled with fluid to help the surgeon have a better view. A laser beam or high electric voltage is usually used to vaporize the uterine tissue. Another technique uses a device that applies heat as it rolls across the uterine lining, destroying the endometrial tissue. In microwave ablation, microwaves are generated inside the uterus to heat and destroy the lining of the uterus. Another way to perform an endometrial ablation is by using a balloon. Here, the lining of your uterus (the endometrium) is destroyed by placing a balloon filled with hot fluid inside the uterus.
In an endometrial resection, the lining of your uterus (the endometrium) is removed. This procedure is highly effective in eliminating heavy bleeding. The cervix is dilated and fluid is pumped into the uterine cavity to help the surgeon have a better view of the uterus. The lining is then removed with an electrosurgical wire loop.
These procedures will not help menorrhagia due to adenomysosis.
Hysterectomy is the surgical removal of the uterus. The most common reason for hysterectomy is heavy bleeding, but this surgery is only done for the most severe cases. In about 40% of cases, the ovaries are removed as well in a procedure called ]]>oophorectomy]]> . This leads to premature menopause in younger women.
There are three main methods of hysterectomy:
Abdominal Hysterectomy – An incision is made in the lower abdomen, and the uterus is removed from the top of the vagina.
Vaginal Hysterectomy – The vagina is stretched and kept open by special instruments; no external incision is made. The doctor does, however, make an internal incision at the top of the vagina around the cervix. The uterus and cervix are removed through the vagina.
Laparoscopically-assisted Vaginal Hysterectomy (LAVH) – A laparoscope is inserted through a small incision near your navel. This small, telescope-like device, about the width of a pencil, with a light on one end and a magnifying lens on the other, helps the doctor see the pelvic organs. Your abdomen is inflated with a harmless gas (carbon dioxide) to improve the doctor's visibility and to provide room to work. The uterus is removed through the vagina.
American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/ . Accessed February 28, 2006.
American Medical Association website. Available at: http://www.ama-assn.org/ . Accessed February 28, 2006.
American Society for Reproductive Medicine website. Available at: http://www.asrm.org/ . Accessed February 28, 2006.
Last reviewed February 2007 by ]]>Jeff Andrews, MD, FRCSC, FACOG]]>
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