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Endometrial ablation is a quick outpatient treatment for heavy bleeding.
Endometrial ablation is the removal or destruction of the lining of the uterus (endometrium). It does not require hospitalization, and most women return to normal activities in a day or two. Ablation is an alternative to hysterectomy for many women with heavy uterine bleeding who wish to avoid major surgery. After a successful endometrial ablation, most women will have little or no menstrual bleeding. Patient selection and physician experience is essential to a good outcome.
How is endometrial ablation done?
Endometrial ablation has traditionally been done using a hysteroscope. I did my first endometrial ablation at Virginia Beach General Hospital 1985 using a ND-YAG laser. My results using the laser were o.k., but it was a slow, difficult procedure. In an effort to improve effectiveness and safety, I evolved through multiple techniques. First was the rollerball, then the roller-cylinder, next was the resectoscope. The resectoscope is a special type of telescope with a wire loop. It allows me to see inside the uterus and uses high-frequency electrical energy to cut or coagulate tissue. The resectoscope has the advantage of being able to remove polyps and some fibroids at the time of ablation. However, It takes extensive experience and skill to be able to safely use the resectoscope, and obtain this degree of success. I have done many ablation cases gaining experience for over 25 years. Next came the "Global Methods".
What are the methods of endometrial ablations?
In experienced hands, the resectoscope provides excellent results however, the technique is difficult to Master. Other methods of ablation have been investigated including "Global Methods" Microwave ablation, Hydrothermablation, Cryoablation, ThermaChoice balloon and Novasure or Minerva. There are even more devices available in this country and other countries, but I think that their disadvantages outweigh their advantages.
I use either the Novasure or Minerva Endometrial Ablation
Recovery from endometrial ablation
Most women are able to go home within an hour after an endometrial ablation. There may be mild cramping, which can usually be relieved by ibuprofen. Occasionally stronger medicine may be needed. It is normal to be tired for a few days, but most women are able to return to most normal activities in a day or two. Intercourse and very strenuous activity is usually restricted for 2 weeks. It is normal to have a increased discharge for 2 to 4 weeks afterward, as the lining is shedding. I normally do the first check-up 4 weeks afterwards.
Who should consider endometrial ablation?
Women who have menstrual bleeding that is impacting their life, and do not have other problems that require a hysterectomy should consider endometrial ablation.
Risks of endometrial ablation
There are risks to endometrial ablation, which should be compared to the risks of things we do in every day life. A number of things can be done to reduce these risks. Some of the risks of endometrial ablation procedures are perforation of the uterus, absorbing excess fluid, bleeding, infection, injury to organs within the abdomen and pelvis, and accumulation of blood within the uterus due to scarring. Another rare, but important, concern after any endometrial ablation procedure is that it might decrease your doctor's ability to make an early diagnosis of cancer of the endometrium. Abnormal bleeding should be evaluated whether or not you have had an ablation.
A small percentage of properly selected women having an ablation will still eventually need a hysterectomy, but the great majority will not. Having done endometrial ablation since 1985, I can often identify women who will have a successful ablation and those who would be better off with other treatment.
Who shouldn't have an endometrial ablation?
Since an endometrial ablation destroys the lining of the uterus, endometrial ablation is not for anyone who desires to keep her fertility. Women who have a malignancy or pre-malignant condition of the uterus are not candidates for ablation. Women who have severe pelvic pain, unless the pain is coming from an intracavitary myoma, may be better served by alternative treatments. Although pregnancy is unlikely after ablation, serious complications could arise. It is essential to use reliable contraception (tubal ligation or vasectomy) after an endometrial ablation.
Who can help me decide if an endometrial ablation is for me?
It is helpful to see a gynecologist who is familiar with, and who is able to provide all of the alternatives for the treatment of your problem. A physician who does not do endometrial ablation on a regular basis is unlikely to have the experience to help you make the best decision. The physician should be expert at vaginal-probe ultrasound and at diagnostic hysteroscopy, and should consider non-surgical treatments, as well as discussing the advantages and disadvantages of all the options available. While the physician can provide you with information, the decision is ultimately yours.