Are there any known causes for heavy bleeding that cannot be controlled by hormonal treatments or birth control pills?
Oral contraceptives (birth control pills) can certainly fail to control heavy bleeding. The more important issue is not to routinely use oral contraceptives to control heavy bleeding, but rather to evaluate the bleeding properly to determine the cause. Once this is done, therapy is aimed specifically at the cause of the bleeding. If all the known causes of bleeding are ruled out by testing, and the woman is still having heavy bleeding, then the condition is called dysfunctional uterine bleeding, or DUB. The first treatment of DUB is always medication. Multiple medications are available. Often, oral contraceptives are used. In many cases bleeding can be controlled with medication, at least enough to "tide the woman over" until menopause, at which time obviously bleeding will cease completely on its own. If the bleeding from either uterine fibroids or dysfunctional uterine bleeding is causing truly excessive blood loss (causing low blood count or anemia, for example), then many different types of procedures are available. Endometrial ablation is one of the many procedures.
Unfortunately, the final answer of which procedure is "best" is not available. There is no such thing as best right now. What exists is some information regarding some possible advantages and disadvantages of hysterectomy compared to endometrial ablation. Studies are currently in progress that will give more information for women and their physicians to juggle in making these decisions.
For more information, please see MedicineNet's Vaginal Bleeding article.
Last Editorial Review: 3/7/2002