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Abnormal Bleeding and Endometrial Ablation
- What is menorrhagia?
- What are the treatment options?
- Who is a candidate for endometrial ablation?
- How does endometrial ablation work?
- What can I expect after the procedure?
What is Menorrhagia?
Menorrhagia is excessive menstrual bleeding. If your bleeding lasts seven or more days per cycle, or is so excessive that you need to change protection nearly every hour, you may have menorrhagia. Only your doctor can tell you for sure. Women suffering from menorrhagia can experience fatigue, anemia, embarrassing accidents, and restricted activity. If you're familiar with these effects, you know that menorrhagia can disrupt your life. And you are not alone. About 1 in 5 women experience unusually heavy menstrual bleeding. And there are now more treatment options available to you.
What are the Treatment Options?
- Drug therapy is typically the first treatment option, consisting of oral contraceptives or other hormones that treat hormonal imbalances. This therapy is effective only about 50% of the time, and usually must be continued in order to remain effective. Some women experience undesirable side effects, including headaches, weight gain, and nausea.
- Dilation and curettage (D & C) is frequently the second option if drug therapy is ineffective. It is a common surgical procedure that involves scraping of the inside of the uterus. However, for the majority of women with menorrhagia, it's only a temporary solution that reduces bleeding for a few cycles.
- Hysterectomy or surgical removal of the uterus is the only definitive treatment for menorrhagia. Hysterectomy is a major procedure, performed in the hospital under general anesthesia, and is accompanied by surgical risks, hospitalization, and, depending on the technique used, a recovery period of up to 6 weeks.
- Endometrial ablation - If you do not plan to have
any more children, your doctor may suggest minimally invasive surgical
treatment options. Several methods are currently available:
- Conventional endometrial ablation removes the lining of the uterus with an electrosurgical tool or laser. This method effectively reduces bleeding in approximately 85% of patients, and most women return to work within 3 days. Risks include perforation of the uterus, bleeding, infection, or even heart failure due to fluids used to open up or distend the uterus.
- A new generation of endometrial ablation devices is now available. Some devices destroy the endometrium by using heated fluid. Others use freezing temperatures to destroy the tissue. Recently, the NovaSure™ System, which uses a precisely controlled dose of energy, was made available for use in the U.S.
Who is a Candidate for Endometrial Ablation?
Pre-menopausal women with heavy menstrual bleeding who have completed childbearing may be candidates for the NovaSure™ procedure. Your physician may perform diagnostic tests to rule out other abnormal uterine conditions, and your Pap smear and biopsy must be normal. Answering "Yes" to any of the questions below may mean you are a candidate for this minimally evasive procedure:
- Do you regularly experience heavy bleeding?
- Does your bleeding last 7 or more days per cycle?
- Is your bleeding so heavy it requires you to change protection nearly every hour and to carry large amounts of feminine product with you?
- Has medication (birth control pills) failed to help you in your heavy bleeding?
- Do you experience fatigue, anemia, or embarrassing accidents due to your heavy bleeding?
- Does your heavy bleeding affect your social, athletic or sexual activities, or cause you to miss work?
- Do you ever avoid traveling or even leaving your home because of your heavy bleeding?
- Do you often bring an extra change of clothes with you due to your heavy bleeding?
How Does Endometrial Ablation Work?
The endometrial ablation procedure provides an effective and minimally
invasive outpatient alternative to hysterectomy, while avoiding the
potential side effects and long-term risks of drug therapy. The procedure
uses precisely measured electrical energy delivered via a slender, hand-held
device to remove the endometrial lining. The application of energy is
intended to permanently remove the endometrium (lining of the uterus), to
reduce or eliminate future bleeding.
Here's a look at how the procedure works:
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Your doctor will slightly dilate your cervix and insert a slender wand through the cervix into the uterus. |
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The doctor then extends the triangular mesh device through the wand where it expands to conform to the dimensions of your uterine cavity. |
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Electrical energy is then delivered into the uterus on average for approximately 90 seconds. |
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The triangular mesh device is then retracted back into the wand and removed from the uterus. |
What Can I Expect After the Procedure?
The following are some of the post-operative discomforts associated with any endometrial ablation procedure:
- You may experience some post-operative uterine cramping and discomfort shortly after the procedure, which can generally be treated with mild pain medication such as ibuprofen (e.g., Advil® or Motrin®).
- Some patients may experience nausea and vomiting as a result of the anesthesia. Watery and/or bloody discharge after an endometrial ablation is also common for several weeks after the procedure.
Most women can return to normal activities within a day or two of their treatment. Sexual activity can be resumed after your first checkup, usually in 7 to 10 days.
Most women will see a significant reduction in the level of their menstrual bleeding. After 12 months, patients typically had their bleeding reduced to light or moderate periods, and many report that their bleeding has stopped completely. Many women may also experience the added benefits of a significant reduction in painful menstruation (dysmenorrhea), as well as a meaningful reduction in PMS symptoms.