Surgical treatment for heavy menstrual bleeding

See Indications for specialist referral for advice on when surgical assessment is indicated. If surgery is an option, uterine-preserving options are considered before hysterectomy. These include:

• hysteroscopic resection of polyps and small fibroids
• laparoscopic resection of fibroids
• fibroid-necrosing procedures (eg uterine artery embolisation)
• endometrial ablation.

All the above preserve fertility, except for endometrial ablation. Contraception is still needed after ablation, although the risk of pregnancy is very low.

Hysterectomy is indicated for individuals with substantially increased endometrial cancer risk, such as those with endometrial hyperplasia with atypia or genetic predisposition to endometrial cancer¹.