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
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