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What Is Endometrial Ablation?

Monday, March 31st, 2014

Endometrial ablation is a procedure in which a layer of the uterine lining is permanently removed in order to reduce or stop abnormal bleeding. The procedure is performed only on women who do not wish to have any more children. In some cases, it is performed in place of a hysterectomy.

The techniques used to perform endometrial ablation vary and include electrocautery, radiofrequency, cryoablation, and hydrothermal procedures, among others. The procedure is performed on women who are experiencing abnormal bleeding (bleeding between periods) or menorrhagia (prolonged or extremely heavy periods). Abnormal bleeding can be so severe in some cases that daily life is interrupted and some women may even develop anemia.

Reasons for abnormal bleeding and menorrhagia include hormone disorders or imbalances, fibroid tumors, polyps, or endometrial cancer. However, as stated earlier, the lining of the uterus is destroyed during ablation and is no longer able to function normally; therefore, bleeding is significantly lessened or even stopped entirely, and it is important to know that the woman also will no longer be able to become pregnant.

Endometrial ablation carries the same risks as any surgical procedure, including infection, bleeding, perforation of the uterine wall, or complications due to medication sensitivities the patient is not aware of (or neglects to inform the doctor of). In addition, women with certain medical conditions should not have this procedure, and these include vaginal infections, cervical infections, pelvic inflammatory disease, weakness of the uterine muscle, abnormal shape or structure of the uterus, and having an IUD in place, among others. In my health book, “Inside Information for Women”, I discuss this technique under “Resectoscopy”.  Endometrial ablation with cautery via a resectoscope or any other modality is a little tricky if the patient ultimately is found to have uterine cancer.  Why?  Because all the evidence regarding the extent of the disease (cancer) is burned away and the physician will have difficulty in staging the cancer, which is important in formulating the best management for a patient with uterine cancer. 

If your doctor and you decide that endometrial ablation may be right for you, your doctor should explain the procedure to you thoroughly and give you a chance to ask any questions you have. If you are to have a procedure that requires general anesthesia, you will be asked not to eat or drink before the procedure, most likely for at least eight hours or after midnight the night before. Be sure to tell your doctor if you may be pregnant, are allergic to any medications, or are taking any prescription drugs or herbal supplements.

Your procedure may take place in a hospital or in your doctor’s office on an outpatient basis. Recovery will depend on the type of anesthesia and the type of ablation used. In general, you can expect to need to wear a sanitary pad for a few days after the procedure, as bleeding during this time is normal. Also for the first few days, you may experience cramping, frequent urination, nausea, and/or vomiting.

Your doctor will probably instruct you not to use tampons, douche, or have sex for at least a few days. Usually restrictions on other activities are also necessary, such as heavy lifting and strenuous exercise. Let your doctor know if you experience fever, chills, severe pain, difficulty urinating, excessive bleeding, or foul-smelling discharge.

This information applies in general to most ablation procedures, but because each woman and situation is unique, the most important thing to remember is to follow your doctor’s specific instructions, and ask any questions you may have.

– Yvonne S. Thornton, M. D., M. P. H.

Myomas – Also (Wrongly) Known as Fibroids

Thursday, November 7th, 2013

As widely used as the term “fibroids” is, it is, in fact, a misnomer. “Myoma or myomas”  is the proper name for these tumors of the uterine muscle.

Myomas can be many different sizes and are typically hard and rubbery. They grow slowly and can occur at any time in any woman. 25 percent of all women have myomas, while 50 percent of black women do. Fortunately, many of these myomas are small and require no treatment. There can be just one or dozens in one uterus, and each one can be smaller than a pea or as large as a cantaloupe – or anywhere in between.

If your doctor tells you that you have a myoma, there are some questions you should be prepared to ask. You’ll want to know how big it is, how many of them there are, and where in the uterus they are located. Furthermore, you’ll want to discuss any symptoms it may be causing. A diagnosis of myomas often leads to hysterectomy, but sometimes this is an unnecessary overreaction, so talk to your doctor about possible other treatments, or whether treatment is needed at all.

For example, at menopause, myomas often shrink. This is because they are largely dependent on estrogen, so when estrogen output dwindles, myomas shrivel. They may not disappear completely, but if they are small enough and not causing symptoms, then there is often no reason to treat them.

However, some myomas can cause troublesome symptoms such as pain, irregular heavy bleeding, frequent urination, or problems with defecation caused by pressure on the colon. Another problem with myomas is that they can be hard to distinguish from ovarian cysts and tumors. Because they are slow-growing, though, it’s usually fine to monitor their growth through repeated examinations. If they stay the same size over time, this is a good sign. However, a growing myoma is a concern that requires some type of follow-up, usually exploratory surgery.

If a myoma needs to be removed, there are still different options for women and their doctors to explore. A myomectomy isolates and removes each myoma, while a hysterectomy removes the entire uterus. A woman who wants to preserve her ability to have children may opt for a myomectomy, but she should realize that this operation is difficult and complications are likely, so if she is older or certain that she does not want to have more children, then a hysterectomy is a much safer, simpler option.

There are new alternative treatments for myomas that are not recommended for women who still want to have children, because their newness calls into question the wisdom of recommending them; you can find more information about these treatments in my book, Inside Information for Women. But the fact remains that hysterectomy is the safe, rational course of action for myomas in women who do not want any more kids. Therefore, if you are symptomatic, menopausal and/or have completed your family, your  gynecologist may offer the definitive treatment of hysterectomy.

– Yvonne S. Thornton, M. D., M. P. H.

Painful fibroids? An alternative to surgery

Friday, August 27th, 2010

Plenty of us suffer from fibroids (medical term is myoma), which are benign tumors that form in the uterus.  Up to 40 percent of all women will be diagnosed with fibroids at some point in their lives, but only a relative few have severe symptoms. If you’re among the unlucky ones, and you’ve had to cope with extreme cramps and heavy bleeding during your period, backaches, painful sexual intercourse, or urinary problems, you might believe that the only way to end the misery is by getting a hysterectomy.

But there is another treatment, one that has been proven effective for many women, and doesn’t require surgery. Uterine artery embolization (UAE) is a minimally invasive outpatient or inpatient procedure performed by an interventional radiologist.  Using a small x-ray camera (fluroscope), small, inert particles (embolic agents) are injected through a thin, flexible tube called a catheter into the arteries that nourish the fibroids and essentially block the blood flow, thus causing the fibroid to shrink.

A recent study in the American Journal of Obstetrics & Gynecology showed that for the vast majority of women, five years after the procedure was done, UAE had relieved symptoms enough so that a hysterectomy was not required.

Of course, any procedure has risks and there is always the possibility of side-effects from any treatment. But for women who suffer greatly from painful fibroids, who want to avoid a hysterectomy, UAE is an alternative worth considering.

– Yvonne S. Thornton, MD, MPH