Gynecology - Endometrial ablation
Endometrial ablation is a medical procedure that removes the lining of the uterus, called the endometrium. If your periods are very heavy or last too long, we may prescribe medications that will cause you to have a lighter period. If the medication does not work, we may recommend endometrial ablation. After endometrial ablation, up to 50 percent of patients have no further bleeding, and a smaller percentage of patients experience lighter menstrual periods.
Women who are pregnant, who would like to have children in the future or who have gone through menopause should not have this procedure. In addition, endometrial ablation is not a form of birth control and you will still need to use birth control! Endometrial ablation does make it less likely that you will get pregnant, but not impossible. If you have an intrauterine contraceptive device, you must have it removed before endometrial ablation. Non-cancerous or pre-cancerous growths can't be treated with endometrial ablation.
About 9 out of 10 women have lighter periods or no period after endometrial ablation. These improvements may not last forever, though. Your periods may get heavier and longer after several years. If this happens, you may need to have a hysterectomy.
The endometrium is living tissue and can be destroyed using virtually any form of energy or temperature extreme. There are three technologies available at Women’s Health Associates and we are the only practice in the area that offers these services in an office setting:
- Novasure
The Novasure System is the latest generation of devices that treat the entire inside of the uterus (endometrial cavity) at once. The procedure does not require any incisions, and does not require hospitalization. A slender device is inserted through the cervix under local anesthesia with oral sedation. Once the deviceis in place, treatment time averages 90 seconds. Most women can resume most of their normal activities in a day or two.
Before endometrial ablation is done using most other methods, it is necessary to thin the lining of the uterus with hormonal medication that induces temporary menopause or with birth control pills. Some of these medicines can have troublesome side effects. Also, with other devices the ablation must then be done at a specific time of the menstrual cycle. A major advantage of Novasure is that hormonal pre-treatment is not needed, and it can be done at any time of the cycle.
- Under local anesthesia, a sheath containing the electrode (the part that does the ablation) is placed through the cervix. The sheath is pulled back, allowing the electrode to expand and conform to the shape of the uterine cavity.
- The system inflates the uterus with a small amount of CO2 to ensure proper placement of the device.
- The device is activated, and automatically turns off when it senses that treatment is complete. Usually this takes about 90 seconds.
- After ablation is complete, the electrode safely retracts into the sheath for easy removal.
- Most women are ready to go home within an hour after the procedure.
The Novasure System is the most rapid of all endometrial ablation techniques. FDA studies show that it has a high success rate and low complication rate. It can be done under local anesthesia (usually with sedation) or asleep. One of the biggest advantages is that no hormonal pretreatment is needed, and it can be done at any time of the menstrual cycle.
The size and shape of the uterus must be fairly normal in order to use the system. Fibroids or large polyps inside the cavity of the uterus will interfere with the placement of the device. The Novasure system, however, is approved in patients with smaller polyps, up to 2 cm, without having to first remove the polyps. It can also be used to treat a uterus that has fibroids as long as the fibroids do not distort of the shape of the cavity.
- Thermachoice
Thermachoice is an endometrial ablation technology that places a hot water filled balloon in the uterine cavity. The balloon conforms to the shape of the uterus, and the hot water effectively destroys the endometrium.
First, a soft, flexible balloon attached to a thin catheter (tube) is inserted into the vagina through the cervix and placed gently into the uterus.
Then the balloon is expanded with a sterile fluid that expands to fit the size and shape of your uterus. The fluid in the balloon is heated to 188° F and maintained for 8 minutes while the uterine lining is treated.
When the treatment cycle is complete, all the fluid is withdrawn from the balloon and the catheter is removed. Nothing stays in your uterus. Your uterine lining has been treated and will slough off like a period in the next 7-10 days.
Although this procedure takes longer than the Novasure to perform, it is generally easier to perform because no dilation of the cervix is required. Patients generally find this procedure somewhat easier to tolerate than the Novasure.
Caution: Thermachoice contains natural latex rubber which may cause allergic reactions.
- Her Option
Her Option uses cryoablation (cold temperatures) to reduce or eliminate the uterine lining. Because cold is a natural pain killer, anesthesia generally is not needed during this procedure. Thermal ablation, however, uses energy or heat to destroy the uterine lining and generally requires some form of anesthesia.
Unlike Novasure and Thermachoice, Her Option has always been intended as an office-based procedure. The cervix does not need to be dilated, and the use of cold to destroy the endometrium results in an ablation method that is generally acknowledged as the least painful of all the available modalities.
However, evidence suggests that cryoablation probably is not as effective as the Novasure and Thermachoice technologies.