Vaginal Hysterectomy Vs. Endometrial Ablation

Careful considerations must be made before deciding on the proper surgery.
Careful considerations must be made before deciding on the proper surgery. (Image: Image by, courtesy of Avi Bolshakov)

When a woman’s life has been severely affected by heavy vaginal bleeding, a vaginal hysterectomy or an endometrial ablation may be the perfect remedy to relieve this uncomfortable gynecological problem. As with any life-changing decision, the advantages, disadvantages and risks should be carefully mulled over with a doctor before deciding on the right one.


A vaginal hysterectomy is an outpatient surgical procedure that removes a woman’s uterus directly through the vagina. Women generally choose this method to stop heavy vaginal bleeding, remove benign fibroid tumors, relieve chronic pelvic pain or to treat uterine prolapse. In some cases, the cervix, fallopian tubes and one or more of the ovaries are also removed at the same time. Endometrial ablation effectively treats heavy periods by removing only the lining of the uterus.


A vaginal hysterectomy removes a woman’s uterus through a surgical incision made in her vagina. Her vagina may be packed with medicated gauze to encourage faster healing, and the incision is stitched closed. In an endometrial ablation, a surgeon uses a hysteroscope to view a woman’s uterus, and the lining is removed by using electrical currents, laser beams, microwave heat or by using a balloon-type device filled with heated fluid.


Women who undergo a vaginal hysterectomy will either remain in the hospital for one to three days or be allowed to go home the same day. Bleeding will continue for several days, and pain medication and antibiotics to prevent infection are prescribed. According to the Mayo Clinic, “most women feel better within a week and make a full recovery in one to two weeks.” Women who undergo an endometrial ablation may need to take mild painkillers and shouldn’t use tampons for at least a month.


Women who undergo a vaginal hysterectomy will no longer menstruate. According to the Mayo Clinic, “many women report improved mood and increased sense of well-being.” Some women may have a better sex life, and pelvic pain disappears. After an endometrial ablation, some women may stop menstruating, while others may experience lighter periods.


Women who undergo a vaginal hysterectomy will never be able to have a baby. Some women become depressed and grieve after the loss of their uterus, especially women who long to become pregnant. Once an endometrial ablation is performed, a woman may experience heavy bleeding again some time in the future, so the procedure may have to be done again. Fertility is also severely affected after an endometrial ablation, so women who want to become pregnant may need to seek alternative treatment. Successful results of an ablation may not be noticed for about three to six months.


The risks of vaginal hysterectomy are minimal, but may include blood clots, infection or allergic reaction to anesthesia. Women who are overweight, diabetic or who have high blood pressure are at higher risk. There is also a slight risk of injury to the bladder, ureters or the bowel while the procedure is being done. An endometrial ablation is relatively risk-free, except some women may have an adverse reaction to the anesthesia or may develop an infection. Blood clots may also occur but are rare.

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