What is an endometrial ablation and why is it performed?
There are more than 600,000 hysterectomies performed in the United States each year. Many of these hysterectomies are performed for significant vaginal bleeding problems. When the bleeding is not associated with malignancy and the uterine cavity is not obstructed, ablation of the endometrium to control bleeding may now be considered as an alternative to hysterectomy. You should not have this procedure if you still want to have more children, have a malignancy or premalignant condition of the uterus, have large uterine fibroids, or have hyperplasia which is an overgrowth of the uterine lining.
What are the advantages?
The advantages of ablation over hysterectomy to control vaginal bleeding are:
Decreased time away from normal activities.
Decreased cost to provide the procedure.
Less surgical risk for the patient.
Minimal discomfort following the procedure.
You will be able to go back to work within 2 to 3 days, whereas recovering from a hysterectomy takes up to 6 weeks.
The procedure is performed in the office; therefore, hospital costs are kept to a minimum.
What should I expect the day of the procedure?
Dr. Hardy will first numb the cervix and uterus by administering a paracervical block of 1% Lidocaine with epinephrine. He will then dilate the cervix, perform a hysteroscopy (looking inside the uterus with a small thin rod with a telescope on the end). Dr. Hardy will then perform the ablation using a special vaginal probe inserted into the uterus. The device uses heat to damage the lining of the uterus. Immediately following the procedure, some patients feel cramping similar to a menstrual period. You will already have your Vicodin to take for the pain. You may also use a heating pad or Motrin. You should take it easy for the rest of the day. Most patients can return to normal activities within a day or two. You may experience a watery discharge for up to 4 weeks following the procedure as the tissue heals. You should not use tampons, douches or have sexual intercourse for 4 weeks after the procedure.
What should I expect after having an endometrial ablation performed?
Within the first 3 months following treatment, you should experience a reduction in bleeding. It is not unusual to experience 2 or 3 normal menstrual cycles before you see the full extent of the treatment to take effect, although some patients see results immediately. The decrease in bleeding varies from woman to woman. Some women find that the periods return to normal levels, while others find that their bleeding is completely eliminated or reduced to spotting. In a clinical study, it was determined that 80% of women found the therapy to be successful. In addition, they often reported a reduction in PMS symptoms such as fatigue, irritability and cramping. The treatment should not change you desire for or your enjoyment in sexual activity.
What are the possible complications from the procedure?
Complications of ablation are rare, but may include blood loss requiring a transfusion; perforation of the uterus, or unintended damage to other internal organs. The lining of the uterus has regenerative properties (repair or replacement of cells), and in some women, heavy vaginal bleeding may recur. Infection is always a possibility but can be treated with antibiotics. If pregnancy occurs following ablation, the uterus lining may not be adequate for a fetus to attach and grow within the uterus and a miscarriage may occur.
Complications of ablation are rare, but may include blood loss requiring a transfusion; perforation of the uterus, or unintended damage to other internal organs. The lining of the uterus has regenerative properties (repair or replacement of cells), and in some women, heavy vaginal bleeding may recur. Infection is always a possibility but can be treated with antibiotics. If pregnancy occurs following ablation, the uterus lining may not be adequate for a fetus to attach and grow within the uterus and a miscarriage may occur.
When should I call the office?
Call your provider right away if:
You have heavy bleeding from your uterus (you need more than 1 pad or tampon per hour or the bleeding is heavier than your menstrual flow).
You develop a fever over 100°F (37.8°C).
You have severe abdominal pain or abdominal pain that continues even after you take acetaminophen or aspirin.
You have a foul-smelling discharge from the vagina.
