What is Cryoablation 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. In the future, this procedure may make the hysterectomy for abnormal vaginal bleeding unnecessary. 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.
- Avoids the risks involved with general anesthesia.
- 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 to expect prior to the procedure?
You will come to the office for a preoperative appointment the afternoon before the procedure. You should have received 3 prescriptions in the mail and bring them with you to the preoperative appointment. During this visit, the Nurse Practitioner will have you sign all consents, review the procedure, recovery expectations, potential risks and complications and review the following medications with you:
- Vicodin which is a tablet taken by mouth for pain relief
- Toradol which is a liquid that you bring with you to the procedure. It will be injected in your upper arm and helps with inflammation and cramping.
- Misoprostol which is a table that the Nurse Practitioner will place in the vagina to help prepare the cervix for the procedure.
- Valium which will be 2 tablets. You will take the first one 1 hour prior to your procedure, and then the second one ½ hour prior to your procedure. You will need to have someone drive you to and from the procedure because of this medication. It will help you relax but may also make you feel drowsy.
What should I expect the day of the procedure?
After taking you Valium as directed and having someone drive you to your procedure, you will have your blood pressure and weight taken. After this, the nurse will take the Toradol that you brought with you and give you the injection in the muscle of your upper arm. You will be escorted to the exam room and lay on the examination table as you would during a pelvic exam.
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) and a sample of endometrial tissue will be obtained and sent off to the lab for evaluation. Dr. Hardy will then perform the cryoablation using a special vaginal probe inserted into the uterus and begin freezing the lining of the uterus. Each freeze cycle will last between 5 and 7 minutes for both the right and left side. We will use the Ultrasound machine to monitor the freezing process. 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 cryoablation 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 94% 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 have regenerative properties (repair or replacement of cells), and in some women, heavy vaginal bleeding may recur. Infection is always a possibility but can often 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 the office 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.