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Endometrial Ablation

WHAT IS ENDOMETRIAL ABLATION?

Endometrial ablation is the destruction of the endometrium. In women with heavy menstrual bleeding, it is an alternative to uterus removal. Most women who have had a successful endometrial ablation will have little or no menstrual bleeding.

HOW IS ENDOMETRIAL ABLATION DONE?

Endometrial ablation is usually done using a hysteroscope or resectoscope. Although results of endometrial ablation using the laser are excellent, it is more efficient to use a high-frequency electrical current delivered through a resectoscope.  The resectoscope can also be used to remove fibroids that are inside the cavity of the uterus and polyps. 

WHAT ARE THE DIFFERENT TYPES OF ENDOMETRIAL ABLATION USING THE RESECTOSCOPE?

Firstly a "roller-ball" endometrial ablation in which a ball-shaped electrode is used to destroy the endometrium.  In another method called "endo-myometrial" resection, a loop electrode is used to shave off the endometrium and some of the underlying tissue.

DOESN'T D&C ALSO REMOVE ENDOMETRIUM?

Yes, but a D&C is a blind procedure in which the lining of the uterus is scraped the aim being to remove the implanted pregnancy, whereas here the endometrium is REMOVED. It can be compared to mowing a lawn to removing the "soil".

FAQ's

Will I still have periods after ablation?

Endometrial ablation is done to treat abnormally heavy menstrual bleeding.   Most women will have no period or very light periods after the procedure.   If you wish to be guaranteed that you will never have another spot of blood; only a uterus removal can assure that.  On the other hand, most women with menstrual periods that interfere with their normal activities will be very happy to have light menstrual periods after a short outpatient procedure.  Amenorrhoea occurs in more than 50% of women.  Most postmenopausal women, however, will not have any further bleeding after treatment.

How can I still bleed after an endometrial ablation?

The most common cause of continued bleeding is regrowth of the endometrium from adenomyosis (a condition in which the lining of the uterus grows into the uterine wall).   Deep adenomyosis is one of the most common causes of failure of the procedure. If deep adenomyosis is suspected, an endometrial ablation may not be the best procedure. 

If I have fibroids (myomas) can I still have an ablation?

Fibroids that are inside the uterus (intracavitary or submucous) can often be removed at the time of an ablation.  If fibroids are in the wall of the uterus, they cannot be reached

Who else shouldn't have an endometrial ablation?

Since an endometrial ablation destroys the lining of the uterus, the procedure is not for anyone who desires to the option of conceiving in future.  Women who have a malignancy or pre-malignant condition of the uterus, those who have severe pelvic pain, are better served by alternative treatments and are not candidates for ablation

Who should consider endometrial ablation?

Most women who have menorrhagia (abnormally heavy menstrual periods) that is not controlled by medicine, and do not have other problems that require a hysterectomy should consider endometrial ablation.  The risk is low in the hands of a physician skilled in the procedure.  The procedure is done on an outpatient basis, and most women are able to return to their regular activities in several days.  A small percentage of properly selected women having an ablation will eventually need a hysterectomy, but the vast majority will not.

Do all gynecologists perform endometrial ablation?

No, not all. It is always helpful to see one who is familiar with, and who is able to provide all of the alternatives for the treatment of your problem.


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