Endometrial Ablation

Something a lot of women face as they get older is prolonged heavy periods.  It becomes an issue when women go off birth control because they have a tubal ligation, or their husband has a vasectomy, or when women get close to menopause.  It can be frustrating, embarrassing, and a real annoyance.

There are several ways to manage this.  First, though, an evaluation needs to be done to determine the potential cause for the abnormal bleeding.  This usually involves an exam, a pelvic ultrasound, and sometimes an endometrial biopsy to rule out precancerous or cancerous cells in the uterus if you are at high risk.  Based on this information, your doctor may recommend birth control pills, a Mirena IUD, surgery, or an endometrial ablation.

Endometrial ablation involves destroying the endometrium, the layer of cells in the uterus that builds up every month and is shed when you have a period.  The cells can be destroyed in many different ways, including burning them with electrocautery, freezing them, or heating them.  In our office, we predominantly use two types of endometrial ablation, namely Novasure and HydroThermal Ablation (HTA).  There are other systems available as well.  This procedure can be safely performed in the office setting, under local anesthesia with pain medications, avoiding the risks of general anesthesia.

Endometrial ablation is very effective.  About 2/3 of women stop having periods after having had an ablation, and almost all other women return to "normal" periods.  Rarely,  women will continue to have heavy bleeding, and will eventually require a hysterectomy to control their symptoms.

It is important to be certain that you are finished with childbearing before you have this procedure.  Since the cells that would normally support a growing pregnancy are being destroyed or weakened, if a pregnancy were to implant into the uterus after an ablation, the placenta could implant more deeply into the uterine wall, leading to a potential pregnancy loss and/or catastrophic hemorrhage at delivery.   Women who have active infections of the reproductive tract, or anatomical abnormalities also may not be candidates for ablation.

The procedure involves a paracervical block - local anesthetic injected around the cervix, then hysteroscopy (looking into the uterus with a camera through the cervix) and then a 2-10 minute ablation.  Usually then surgeon repeats the hysteroscopy to make sure the endometrium is sufficiently destroyed and that there have been no complications.  The entire procedure takes roughly 30 minutes.

Complications are unusual but could include uterine perforation (meaning a hole is made through the uterine wall which could result in injury to internal organs), infection, and bleeding.  These risks are similar to IUD insertion, and in general less dangerous than risks encountered for hysterectomy.

Endometrial ablation has been a very safe and effective alternative to hysterectomy for management of abnormal uterine bleeding.  If this is an issue for you, talk to your doctor to discuss your options.

Here are links for more information:

Novasure Endometrial Ablation

HydroThermal Ablation