Since the late 1980s, some gynaecologists have been removing or destroying the
endometrial lining of the womb (endometrial ablation).
The advantage of this new technique is that patients are only in hospital for one or two days and are often back to work after two or three weeks.
Following endometrial ablation, the majority of patients experience reduced blood loss.
However, at least 70% continue to have periods and even the most successful and experienced surgeons have shown that 20-25% of their patients will require a second operation (repeat
endometrial ablation or hysterectomy) within two years.
Endometrial ablation may not destroy all the endometrium so that sterilisation is not guaranteed and contraception is still required.
Endometrial ablation is generally only recommended if there is dysfunctional uterine bleeding
(No cause such as fibroids).
Patients must have an endometrial biopsy before the
endometrial ablation.
There has been no reduction in the incidence of hysterectomy resulting from the introduction of endometrial ablation suggesting that ablations are additional procedures to hysterectomy rather than a replacement.
If heavy menstrual
bleeding does not respond to medication, and your family is
complete, your doctor may suggest endometrial ablation.
It does not remove the uterus.
The main advantage of endometrial ablation is that the uterus is
conserved.
Endometrial ablation is a relatively
minor procedure compared to hysterectomy.
Endometrial ablation is provides a hysterectomy alternative for many women with heavy uterine
bleeding who are wish to avoid major surgery.
Endometrial ablation is an attractive option for women who would
have required hysterectomy but who have serious medical problems
making major surgery dangerous.
The late effects of endometrial ablation are not known. We do not know how women having endometrial ablation will be affected when they go into their fifties, sixties, seventies and eighties: It will take another forty or fifty years before we have the answers.
After endometrial ablation, some women still have light
bleeding or spotting which may persist for several weeks. Many women may have
regular periods following endometrial ablation. This is because the ovaries and
uterus are conserved during the endometrial ablation. If
endometrial ablation does not control heavy
bleeding, further treatment or surgery may be required.
Most women cannot conceive after endometrial ablation.
You should, however,
continue to use some form of birth control until after
menopause. You also may want to think about sterilization as an option to
prevent pregnancy.
Endometrial ablation does not affect sexual response.
A woman who has had
endometrial ablation has all her reproductive organs in place. Because
of this, routine Pap tests and pelvic exams
are still needed after endometrial ablation.
Endometrial ablation is not recommended if you have a high
risk for endometrial cancer such as severe endometrial
hyperplasia.
Endometrial ablation
is a short procedure and this is one of its advantages as a
hysterectomy alternative. It is frequently performed as outpatient surgery in most cases. This
means you can go home the same day.
You will
be given some form of pain relief or sedative to
help you relax before the procedure. The type of pain relief
used depends on the type of endometrial ablation procedure,
where it is done, and your wishes.
There are no
incisions (cuts) involved in endometrial ablation.
There are several techniques for ablating the endometrium.
Electrical (Diathermy) Endometrial Ablation
A loop or rollerball
tool can be used to ablate the thin endometrial lining of the
uterus. For the procedure, the walls of the cervix are dilated
to allow passage of a device called a
hysteroscope. The
doctor looks through it to see the inside of your uterus on a
monitor screen. Your uterus is filled with fluid to expand it.
Then, the ball or loop is pulled across the endometrial surface.
The rollerball or loop applies an electric current to the
surface as it is pulled across the lining. This current destroys
the endometrial lining.
Laser Endometrial Ablation
A laser device burns
the lining using a high-intensity light beam. Like electrical
endometrial ablation, the laser reaches the lining of the uterus
through the hysteroscope. The laser then ablates the endometrial
lining.
Radiofrequency
Endometrial Ablation
The bipolar radiofrequency endometrial
ablation system (NovaSure™) has been
developed to treat women suffering from
menorrhagia due to dysfunctional uterine
bleeding. This technology allows for a
customized, controlled, contoured endometrial
ablation, without the need for hysteroscopic
visualization. Average treatment time for
radiofrequency endometrial ablation is 90
seconds. Active bleeding, at the time of
treatment, is not found to be a limiting factor
for the use of this type of endometrial
ablation. There is some indication that the NovaSure
bipolar radio-frequency endometrial ablation offers slightly
better results than the Thermachoice balloon
endometrial ablation.
Thermal Endometrial Ablation
With thermal
ablation, a device or fluid is inserted into your uterus. Heat
and energy are applied to increase the temperature and destroy
the lining.
My own preference is to use a special fluid filled latex
balloon which is heated in a controlled manner for eight minutes
(Figure 24.5). Special training is required for hysteroscopic surgery,
and their is a learning curve, whereas the latex balloon technique is remarkably simple to use.
The majority of women having balloon (Thermachoice)
as a menorrhagia treatment would prefer to have
it performed in the outpatient setting.0801
Figure 24.4 Balloon
Endometrial Ablation
Risks
of Endometrial Ablation
There is some risk
involved with every surgical procedures.
The endometrial ablation
procedure has certain risks.
The device used may perforate
through the uterine wall damaging adjacent structures such as
the bowel.
Rarely, the fluid used to expand your uterus,
for laser endometrial ablation or diathermy electrical ablation,
may be absorbed into your bloodstream. This may allow too much
fluid in your body and can be serious.
After
the Endometrial Ablation
Some minor side
effects are common after endometrial ablation:
Cramping, like menstrual cramps, for 1-2 days
Small amount of thin, watery discharge mixed with blood,
which can last a few weeks
Frequent urination for 24 hours
Nausea
In most cases, you
can expect to go back to work or to your normal activities
within a day or two of your endometrial ablation.
Effectiveness of
Endometrial Ablation
About 90% of women will have reduced menstrual flow following
endometrial ablation, and 50% will stop having periods.
Younger women are less likely to respond to endometrial
ablation. After an endometrial ablation, younger women are more
likely to continue to have periods and could need a repeat
procedure.
Related Medical Abstracts - Click on the paper title:-
Ablation has the advantage of speed of recovery. If patients are advised before admission for hysterectomy that early discharge home is likely, all domestic arrangements can be made.
For those women who feel that they need surgical treatment for their heavy periods but who are reluctant to lose their uterus, the ablation techniques are attractive.
Even with relatively short follow-up, it has become apparent that a significant number of patients undergoing ablation require further surgery. This means that the overall difference between hospital admission times between ablation and hysterectomy may be less than original estimates and this is also true when comparing economic differences.
The risks of surgical procedures in general, and hysterectomy in particular have been presented (surgery risks and
Q 24.21). Complications can occur with ablation particularly if the uterus is inadvertently perforated (punctured).
In a randomised trial between hysterectomy and transcervical resection (ablation), the effect on health related quality of life at an average of 2.8 years after surgery was evaluated. Those women allocated to hysterectomy had better scores in seven out of eight parameters. The greatest difference was for pain. Twenty eight per cent of those allocated to endometrial resection required a second resection or hysterectomy.0701
Endometrial resection is less likely to be
associated with urinary incontinence than
hysterectomy.
Related Medical Abstracts - Click on the paper title:-
The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.
