Endometrial ablation has become extremely popular over recent years as it is a more conservative approach to those who might otherwise require a hysterectomy to control heavy bleeding, or perhaps aggressive hormonal therapy that might pose other health risks.
As with all the information I offer please understand I love to inform and educate though I cannot possibly diagnose, cure, treat or prevent a condition through this means of communication. You must always make a decision based on a thorough discussion with your primary OB/GYN physician who knows your complete history and physical examination.
Endometrial ablation when I first started learning about it and performing it in the 1990’s was a huge breakthrough in the management of bleeding disorders, serving as a more conservative surgical approach to hysterectomy clearly desired by many women.
Over the years the number of techniques used to perform an endometrial ablation have increased significantly. Whatever the approach, the desired outcome is the same, to ablate (destroy) the menstrual lining (endometrrium) and thus stop the bleeding problem as all that remains is the uterine musculature (myometrium). This article is not the place to discuss the techniques used as this is a constantly changing area in terms of management within the field of gyn surgery and is very much operator dependent.
Here is some useful information as you look into this very popular procedure which I receive many inquires about. This list is by no means complete but will help you think of the appropriate questions to ask your personal physician:
– Clearly there must be no desire for future fertility as the lining to carry a pregnancy is being scarred over.
– If you have an ablation ; however, the procedure should not be viewed as a sterility treatment as islands of active menstrual tissue could remain .
– The procedure has a failure rate in terms of persistent bleeding and this can relate to residual menstrual tissue after the ablation as it can be hard to be sure there has been destruction of the entire lining, deep enough, especially with conditions such as adenomyosis which I describe in the article section of this website. If bleeding persists there can also be increased cramping as the bleeding can be obstructed as a result of scarring over crypts of endometrium deep in the myometrium or uterine muscle.
– When you are past the post-operative recovery phase when bleeding may persist for a while, you must discuss with your doctor when the time is right to re-evalute persistent or recurrent bleeding depending on your particular risk factors.
– One caveat to the comment above , which I have seen is that sometimes the bleeding though persistent might be much lighter and menstrual regularity returns such that the patient wishes to monitor as menses are essentially “back to normal” with regular intervals. Every situation has to be managed on an individual basis. Further evaluation is then determined based on a patient’s particular medical history and the indication for ablation to begin with.
– Should bleeding persist it is not unusual to reablate or ablate using resection if the pre-operative assessment after the first ablation does not point to a more serious problem. I have taken this approach with patients and if not desired then depending on the circumstances one might choose to go to hysterectomy unless this is not an option should the patient not be an operative candidate for major surgery.
– Some of the risks of the procedure include anesthetic risk, relating to the technique chosen, the potential for uterine perforation and the usual operative risk of bleeding and infection relating to surgery in general.
– Most important, as I see it, is the experience of the operator. Although this question may not be comfortably addressed with a physician you know well or have seen for many years.I never took offense to this question as I want to treat a patient who is fully informed. I see nothing wrong with asking what technique is planned to be used, the success rate (no bleeding after the procedure) and roughly how many ablations your provider has performed. All clinicians have to learn new procedures which includes proper training and mentoring and that is something you simply want to know. When I had to learn I let my patient know this is a new procedure and the precautions taken in terms of formal training and mentoring.
– It simply comes down to trust and how confident you feel about your OB/GYN provider and the information you obtain through your personal research. As I often suggest use the American College of Obstetrics and Gynecology website to gather information to help you make an informed decision. acog.org. On the resource page of this website you can go directly to their patient information page. Much of the information is the same as you would receive at your doctor’s offfice.
I hope this information is helpful. The endometrial ablation can be an excellent alternative to hysterectomy if all the criteria are met to insure your safety.
Douglas Penta MD