Endometrial Ablation

Greetings to all of my loyal readers. I hope this finds everyone and their families well and safe this week. This week’s post addresses the many inquiries I receive regarding a procedure called Endometrial Ablation.

Sarah wrote in: “Hi Dr. Boyd thank you for your blog it has helped me a lot. I am 39 years old and have been suffering with very heavy, irregular periods since my last child was born 5 years ago. I have tried everything possible that my doctor has suggested like birth control pills and hormone therapy to try to stop the excessive bleeding but nothing has helped. My doctor has suggested a hysterectomy, but all of my ultrasounds, pap smears and biopsies have been normal. I am so frustrated because I can’t take the time away from work for surgery but I am so tired of bleeding all the time, and the odor that goes with it. I just feel wet and sticky, icky, smelly and definitely not sexy at all. I recently heard about a procedure called “Endometrial Ablation”, where the inside of the uterus is ‘wiped’ away by using heat or freezing to destroy it. They said this will stop the inside lining from coming back every month so women will not have periods or bleeding problems anymore. Can you tell me more? This sounds like it may help me.”

I am so glad you wrote in about this because I see so many women suffering with the exact same problem. I guess the ‘ole uterus just gets worn out after birthing our children and doesn't know what else to do except bleed (joke). This bleeding can be extremely frustrating for both patients and doctors. Especially when all the tests show up as normal, there are no uterine fibroids (myomas), no endometrial polyps, no ovarian cysts or hormone abnormalities and no abnormal paps or biopsies showing a risk for uterine or cervical cancer.

This type of dysfunctional uterine bleeding (DUB) usually consists of very heavy periods (sometimes with blood clots) that usually last 8-10 days, and may or may not be associated with menstrual cramping. When it happens once a month, it may still seem manageable, but for some women it can happen twice a month (or every 14 days). Also, some women will have episodes of long-term bleeding that last up to 30 days or more before it stopping.

Heavy menstrual bleeding is a significant health problem that has been recognized to have a major impact on a woman’s quality of life. Until the introduction of Endometrial Ablation techniques and the Mirena IUD, the only treatment option women had for heavy, frequent menstrual bleeding was hysterectomy. Since the introduction the Endometrial Ablation, the rate of the hysterectomy in the US has dropped by 50%. That’s amazing! There are different ways to perform an ablation and some are more effective than others. It can be done hysteroscopically by using a rollerball with back and forth cautery rolling across each section of the endometrium until the entire area is cauterized. A cutting device can be used as needed to remove any large pieces of lining and clear the area in order to keep moving along. This is very time consuming, and is rarely used and much, much safer and more efficient techniques have arisen.

There are also two types of balloon endometrial ablators, one that uses “thermal” (or hot liquid on the inside of the balloon) and one that uses “cryo” (or very cold liquid on the inside of the balloon). Both of these are done in the same way and have about a 55-60% rate of amenorrhea (significant decrease in the amount of menstrual blood flow). During this procedure you are asleep and a speculum is placed in the vagina and the cervix is gently dilated so the hysteroscopic camera can be placed into the uterus to evaluate for abnormalities, take pictures and gather specimen for the pathology department. Once this is complete, the balloon is placed through the dilated cervix and the cryo or thermal ablation is done by filling the balloon with the fluid and allowing it to work for approximately 6 minutes. The only downfall is the balloons do not fit exactly for every uterus.

The Nova Sure is a newer ablation device that, once place inside the uterus, takes 90 seconds. It uses electricity through a metal triangle-shaped device that is meant to represent the shape of the inside of the uterus. The preparation is the same as previously described with dilation of cervix, but once the Nova Sure is inside the uterus it must be “adjusted” to fit. If it doesn't fit, it won’t work. Again, the problem is the metal triangle does not fit all endometrial cavities so long-term efficacy is not good.

One of the most effective techniques is the Hydothermal Ablator (HTA). It works by circulating hot water (90 degree centigrade) inside the uterus under hysteroscopic visualization. Pictures or video can be taken during the procedure as it cauterizes the endometrium. This has a very effective rate of amenorrhea and decrease menstrual flow (77-80%) and the procedure will decrease need for future hysterectomy.

However you choose to get an ablation you can return to work within a few days because the surgery lasts only a few minutes and requires no incisions. It is done in Doctors office or outpatient surgery centers so you go home within an hour after surgery. Most patient require no pain medication.

It is so liberating to be free of the bleeding and odor and never ending pads and tampons (and free of worry of needing a hysterectomy). Remember that WaterWorks device is FDA Cleared to help rid you of the vaginal odor problems or to feel fresh and clean. It is so wonderful because it uses plain tap water and is totally reusable. It has a sturdy, reusable bag but it’s the unique stainless-steel nozzle with running water that reacts with the vaginal mucosa to eliminate vaginal odor. It can be used every time you bathe/shower because it uses only plain water so it won’t disrupt your own natural vaginal flora. What a relief to have the confidence of knowing you can have a clean, fresh smell everyday.

I hope the above helped you with your decision. Have a safe and wonderful week.

Dr. Susan Boyd, MD