161 N Binkley St., Ste 101
Soldotna, AK 99669
907-260-6914
Endometrial Ablation is an outpatient procedure that involves the removal or the permanent destruction of the lining of the uterus as an alternative to hysterectomy for women who have excessive menstrual or uterine bleeding who have completed childbearing. It is essentially a “permanent D & C.” This procedure does not require inpatient hospitalization, cutting, scars, suturing, or extensive recovery. It is performed as an out patient usually returning the woman to her normal activities in one or two days. This procedure is unique in that it does not change the anatomy, it maintains normal ovarian hormonal function and production, and it is a useful technique to preserve the uterus without the need for long term hormone therapy to try to control heavy menstrual bleeding.
While the procedure is not indicated in women with fibroid tumors, undiagnosed bleeding disorders, with an undiagnosed endometrial polyp, or women who may want to consider future childbearing, it is excellent for long term control of bleeding caused by hormonal dysfunction or intractable menorrhagia (heavy menses), especially where hormonal therapy is unsuccessful or undesired by the patient. The procedure may be appropriate for up to one third of all patients considering hysterectomy and should always be offered as an alternative where appropriate.
The endometrial ablation procedure is not new. It has a long track record of successes since it was first developed in 1979. I began performing the procedure in Alaska in 1990. It appears that the popularity of this procedure as an alternative to hysterectomy is certainly growing as is the instrument technology available to perform the procedure safely and more and more efficiently. All of these techniques require the use of a hysteroscope to look inside the uterus to see and inspect the uterine cavity. Sterile saline using gravity or a low pressure volume controlled pump is used to distend the uterine cavity to create a working space. And, the procedure is usually performed only after the lining of the uterus has been thinned out hormonally for at least one menstrual cycle.
Techniques used now include electrocautery using a “roller-ball” or wire loop (the “gold standard”, over 95% effective in inducing amenorrhea, no menses, or light spotting in my experience), Nd;yag laser (rarely used today, but the original technique described), Thermachoice ballon technique (circulating hot water, a lower success rate), HTA Hydrothermablator (also uses hot water, but outside of a balloon, free flowing in the uterine cavity), Novasure (a freezing device), and Microsolus (a microwave device) all of which have FDA approval. The attempt of the technology is to allow the procedure to be performed faster and with less anesthesia. Fortunately, general anesthesia is painless and the duration of the procedures varies from only about 5 minutes to 25 minutes, making the risk of anesthesia very small (at least 100 times safer than driving in your car). I am not convinced that it makes sense to give up a few minutes to allow a significant decrease success rate, so I continue to perform the “roller-ball” technique, although I have been trained on each of the procedures.
Most women are able to go home within an hour after the procedure. There may be some mild cramping afterwards usually easily relieved with ibuprophen. Most women are able to return to work within one or two days. It is normal to have an increased discharge for about two weeks after the procedure and sometimes there is some mild spotting.
Women who have menstrual bleeding impacting their life, limiting their activity, causing anemia or the need for extra iron therapy, having long cycles and/or limiting intimate time, and who have completed childbearing may want to consider taking advantage of this technology as an excellent alternative to hysterectomy.
For more information or to schedule an appointment for a consultation, please call my office at (907) 260-6914. Our hours are Monday-Friday 8:30-5:30.
Obstetrics
