Abnormal Uterine Bleeding: Should I Have a Hysterectomy?

Abnormal Uterine Bleeding: Should I Have a Hysterectomy?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the facts

Your options

Have a hysterectomy.
Don't have a hysterectomy. You may try other treatment, such as hormones or endometrial ablation. Or you can wait and see if the problem gets better.

Key points to remember

Treatment for abnormal uterine bleeding depends on what is causing it.
Sometimes it gets better without treatment. If you are a teen, your cycles are likely to even out as you get older.
Depending on the cause, abnormal bleeding is often managed with hormone medicine or other outpatient treatments. (These are treatments that don't require a stay in the hospital.)
Taking out the uterus (hysterectomy) stops uterine bleeding. But it is major surgery with short-term and long-term risks. Recovery can take 4 to 6 weeks.
Removing the uterus may be a good choice if menopause is still years away, other treatments haven't helped, and your symptoms are so bad that you're willing to accept the risks of surgery.

FAQs

What is abnormal uterine bleeding?

Abnormal uterine bleeding is menstrual bleeding that isn't normal for you.

Many things can cause this, including abnormal changes in hormone levels. This is most common during the teen years and the years leading up to menopause.

Other causes of abnormal bleeding include fibroids, polyps, cancer, and problems with blood clotting.

You may have abnormal bleeding if you have one or more of the following symptoms.

You have your periods more or less often than normal. A normal adult menstrual cycle is about 21 to 35 days long. A normal teen cycle is about 21 to 45 days.
You have bleeding when you don't expect to, such as between periods or after sex.
Your periods last longer than 7 days.
You have bleeding during your period that is lighter or heavier than usual. With heavy bleeding, you may soak through your pads or tampons often.

What are the risks of abnormal bleeding?

Heavy bleeding can lead to anemia, which can make you weak, pale, and very tired.

Over time, bleeding problems can make it hard for you to have an active life. They can get in the way of sports, sex, and other activities.

How is abnormal bleeding treated?

Treatment for abnormal uterine bleeding depends on what is causing it. Treatments include:

Watchful waiting. Sometimes the bleeding gets better on its own. After a doctor makes sure that the bleeding isn't caused by a serious problem, some people choose to wait and see if their symptoms get better without treatment.
Hormone therapy.
- Birth control pills, patch, or ring can help make your cycle regular, prevent ovulation, and reduce or stop menstrual bleeding.
- Progestin treatment can help you start bleeding normally.
- The levonorgestrel IUD releases a form of the hormone progesterone into the uterus. This reduces bleeding and prevents pregnancy.
Endometrial ablation . The doctor uses a laser beam, heat, electricity, freezing, or microwaves to destroy the lining of your uterus. This treatment may give longer-term relief.
Hysterectomy . This is surgery to remove the uterus. It ends heavy bleeding that can't be stopped in other ways.

What are the risks of hormone treatment?

Birth control pills, birth control patches, and vaginal rings for birth control sometimes cause these side effects:

Tender breasts.
Headaches, nausea, and bloating.
Blood clots. This risk is higher if you are over 35 and smoke.

If you want to get pregnant, you will have to wait until you have stopped taking hormones.

IUDs have other risks, such as:

Infection.
Heavier bleeding.

What are the risks of endometrial ablation?

Problems are rare but can be severe. They include:

Puncture of the uterus.
Infection of the uterus, fallopian tubes, or ovaries (pelvic infection).
Bleeding (hemorrhage).
Blood collecting in the uterus (hematometra).
Tearing of the opening of the uterus (cervical laceration).

What are the risks of hysterectomy?

Problems are rare but include:

Problems related to surgery and anesthesia, such as:
- Blood clots in the legs or the lungs.
- Injury to the bladder or bowel.
- Bleeding.
- Infection.

Why might your doctor recommend hysterectomy?

You have severe symptoms.
You're not close to menopause.
You don't plan to get pregnant.
You tried other treatments, but your symptoms are still bad.

2. Compare your options

	Have a hysterectomy to fix abnormal bleeding	Don't have a hysterectomy to fix abnormal bleeding
	What is usually involved? Surgery takes about 1 to 2 hours. You may stay in the hospital for 2 or 3 days. Recovery usually takes 4 to 6 weeks. You will no longer have periods or be able to get pregnant.	What is usually involved? You may wait to see if the bleeding gets better on its own. You may try hormone medicines, such as birth control pills, progestin pills, or an IUD that contains hormone medicine. You may choose to have a procedure such as an endometrial ablation.
	What are the benefits? Removing the uterus stops all bleeding. You won't have side effects from taking hormone medicine. Surgery lowers your risk of uterine and cervical cancers. For some, sex may be more enjoyable because you won't worry about getting pregnant.	What are the benefits? Bleeding could get better on its own. Other treatments—hormones or ablation—often work well to reduce bleeding. Progestin and birth control pills help make your periods regular. Birth control pills can help ease menopause symptoms and can lower the risk of ovarian and uterine cancer. You may be able to get pregnant when you want.
	What are the risks and side effects? You have the risks from major surgery, which include infection, blood clots, damage to the bladder or bowels, and bleeding. You will no longer be able to get pregnant.	What are the risks and side effects? Hormone side effects may include tender breasts, headaches, nausea, and bloating. Certain birth control pills increase the risk of blood clots. This risk is higher if you are over 35 and smoke. Problems with ablation are rare but can be serious. They may include puncture of the uterus, infection, or bleeding (hemorrhage). If you have ablation, pregnancy is not recommended. Endometrial ablation can cause severe problems with a future pregnancy. And it can cause fertility problems.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about treating abnormal uterine bleeding

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I was surprised when my doctor called my heavy periods "abnormal." He told me that it isn't serious but that I could try a treatment that would lighten the bleeding. I didn't really want to take daily birth control pills. When he said that a special IUD with hormones might control the bleeding, I thought I might as well try it, because it also keeps me from getting pregnant. The IUD worked. I don't have heavy periods anymore, and I feel great."

— Jean, age 29

"I had such bad, heavy periods that I ended up in the emergency room. I was losing so much blood. I tried endometrial ablation. That worked for 3 years, but now I'm just about back to where I started. I'm having a hysterectomy next week, and I'll be so relieved to get rid of the problem once and for all."

— Megan, age 38

"I'd heard that I could take the Pill for my irregular periods, mood swings, and hot flashes. My nurse practitioner wanted to be sure I didn't have anything like uterine cancer. So I had tests and a biopsy first, because at my age, cancer risk is a concern. Anyway, I checked out fine and started the Pill. This helped me. My mood is better, and the bleeding is at least more regular, and it's gotten less and less over the past few months."

— Carlotta, age 45

"My periods were so unpredictable. They drove me crazy! One month, my period might start 3 weeks after the last one and be light, and next time it wouldn't start until 6 weeks later. Then, it would be very heavy and last a long time. When I had heavy bleeding, it was so bad I couldn't exercise. And I'm an active person, so this was really getting me down. I tried hormone medicine for a while, but it didn't help enough. I'm done having kids, so I just wanted to get on with my life. I had a hysterectomy and don't regret it one bit."

— Melissa, age 40

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a hysterectomy for uterine bleeding

Reasons not to have a hysterectomy for uterine bleeding

My symptoms make it hard to enjoy my daily life.

I'm still able to do the things I enjoy.

More important

Equally important

More important

I don't plan to get pregnant in the future.

I may want to get pregnant in the future.

More important

Equally important

More important

I'm worried about the side effects of hormones.

I'm not worried about the side effects from hormones.

More important

Equally important

More important

I've tried everything else, and nothing seems to work.

There are some other treatments I want to try first.

More important

Equally important

More important

The idea of major surgery doesn't scare me.

I want to do everything I can to avoid surgery.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having a hysterectomy

NOT having a hysterectomy

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1. I can have a hysterectomy later if other treatments don't work.

True
False
I'm not sure

You're right. A hysterectomy is still a choice if you try other treatments and they fail to help.

2. For some women, hormone medicines work well to stop uterine bleeding.

True
False
I'm not sure

Yes, that's correct. Abnormal bleeding can often be managed with hormones.

3. A hysterectomy may not be the best choice if I want to get pregnant in the future.

True
False
I'm not sure

Yes, that's correct. You can no longer get pregnant after a hysterectomy.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

Use the following space to list questions, concerns, and next steps.

Credits

By	Healthwise Staff
Primary Medical Reviewer	Kathleen Romito MD - Family Medicine
Primary Medical Reviewer	Martin J. Gabica MD - Family Medicine
Primary Medical Reviewer	Kirtly Jones MD - Obstetrics and Gynecology