Abnormal uterine bleeding surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz, M.B.B.S, Vishnu Vardhan Serla M.B.B.S. [2]

Overview

Surgical procedures are reserved for patients that are unresponsive to medical treatment or those that do not desire fertility. Procedures can be specific according to underlying causes of dysfunctional bleeding as well as cancer stage. Common surgical interventions include hysterectomy, endometrial ablation and laparoscopic removal.

Surgery

As surgery is more invasive, it is often reserved for cases uncontrolled by medications or those not desiring fertility.^[1] Underlying anatomical cases of DUB are also an indication for surgery. Surgical treatments can be tailored according to the underlying cause of bleeding.

Surgical Options

Condiiton

Surgical Treatment^[2]

Polyps

Surgical resection of polyps (polypectomy)
Polyps larger than 1.5 cm are unlikely to respond spontaneously and should consider polypectomy^[3]
Dilation and curettage^[4]

Adenomyosis

Leiomyoma (fibroids)

Hysterectomy (definitive treatment)^[6]

Malignancy ^[7]

Surgical resection +/- adjuvant treatment

Surgical Treatment based on Cancer Stage
Stage	Treatment
1	Transabdominal hysterectomy with bilateral salpingo-oophorectomy
2	Radical or simple hysterectomy along with adjuvant radiotherapy
3	Transabdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic radiation
4	Surgical resection and radiation therapy
5	Palliative care; focus is on improving quality of life

PCOS

Laparoscopic surgery; ovarian drilling

Endometriosis

References

↑ Albers JR, Hull SK, Wesley RM (2004). “Abnormal uterine bleeding”. Am Fam Physician. 69 (8): 1915–26. PMID 15117012.
↑ “StatPearls”. ( ). 2022: . PMID 30422508.
↑ “StatPearls”. ( ). 2022: . PMID 30855861.
↑ Nijkang NP, Anderson L, Markham R, Manconi F (2019). “Endometrial polyps: Pathogenesis, sequelae and treatment”. SAGE Open Med. 7 ( ): 2050312119848247. doi:10.1177/2050312119848247. PMC 6501471 Check |pmc= value (help). PMID 31105939.
↑ Taran FA, Stewart EA, Brucker S (2013). “Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy”. Geburtshilfe Frauenheilkd. 73 (9): 924–931. doi:10.1055/s-0033-1350840. PMC 3859152. PMID 24771944.
↑ “StatPearls”. ( ). 2022: . PMID 30855861.
↑ “StatPearls”. ( ). 2022: . PMID 32965984 Check |pmid= value (help).

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[pmid15117012-1] Albers JR, Hull SK, Wesley RM (2004). “Abnormal uterine bleeding”. Am Fam Physician. 69 (8): 1915–26. PMID 15117012.

[pmid304225082-2] “StatPearls”. ( ). 2022: . PMID 30422508.

[pmid30855861-3] “StatPearls”. ( ). 2022: . PMID 30855861.

[pmid31105939-4] Nijkang NP, Anderson L, Markham R, Manconi F (2019). “Endometrial polyps: Pathogenesis, sequelae and treatment”. SAGE Open Med. 7 ( ): 2050312119848247. doi:10.1177/2050312119848247. PMC 6501471 Check |pmc= value (help). PMID 31105939.

[pmid24771944-5] Taran FA, Stewart EA, Brucker S (2013). “Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy”. Geburtshilfe Frauenheilkd. 73 (9): 924–931. doi:10.1055/s-0033-1350840. PMC 3859152. PMID 24771944.

[pmid308558612-6] “StatPearls”. ( ). 2022: . PMID 30855861.

[pmid32965984-7] “StatPearls”. ( ). 2022: . PMID 32965984 Check |pmid= value (help).

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