A common problem
Every year about 650,000 American women have hysterectomies.
This operation involves surgical removal of the uterus. Many of the women who
have this operation do so because of heavy or prolonged periods.
An alternative
Endometrial ablation offers an effective alternative
to hysterectomy for patients suffering from heavy or prolonged bleeding during
their period. It is often chosen when other medical treatments have failed or
are otherwise undesirable. This procedure involves the removal of the lining
of the uterus, which is the source of the bleeding.
According
to recent studies, most women feel that endometrial ablation relieves the problem
with their period. Up to 90% of women who have this procedure are satisfied
with the results. After the procedure, the women who were satisfied with it
reported lighter periods or normal periods. Some women said that their periods
stopped completely after endometrial ablation.
Tests
Your physician will take your medical history and perform a physical exam to
see if endometrial ablation is right for you.
Other tests could include some blood tests, uterine lining
sampling (biopsy), and hysteroscopy and/or ultrasonography.
These procedures are usually done in your physician's office and are quick and
relatively painless.
Drugs
For 1 to 2 months before the procedure you may have to take medication, possibly
injections, to decrease the thickness of the endometrium
(uterine lining). A GnRH analog may be used for this
purpose. Thinning the uterine lining exposes the lower (basal) layer of endometrial
cells; this is the tissue your physician will remove with electrosurgery.
The day prior to surgery, your physician may choose to place a laminaria
to gradually dilate your cervix the night before your surgery.
What to expect
Endometrial ablation is an outpatient surgical procedure; this means that you
will enter the hospital, have surgery, and usually go home the same day.
The entire procedure usually takes only 15 to 45 minutes. You will then be
taken to the recovery room for rest and observation, and will be allowed to
go home when you have fully recovered from the anesthesia. It usually takes
an hour or two to recover from anesthesia.
The procedure
Endometrial ablation is performed during a procedure called operative hysteroscopy.
A narrow viewing tube is inserted through the vagina and the cervix into the
uterus. A tiny camera attached to the viewing tube (hysteroscope) allows the
uterine cavity to be shown on a TV monitor during surgery. Your uterus is filled
with a harmless liquid to make the procedure easier. The lining of the uterus
is then burned away or vaporized, using a heat generating tool inserted through
the viewing tube.
Your physician may decide to perform a laparoscopy
at the same time to rule out other conditions that could require further therapy.
Afterwards
 |
Your doctor may advise you to:
| |
| -Avoid strenuous activity for a period of time,
usually 24 hours following the procedure. |
| |
| -Refrain from sexual intercourse for a specified
period, usually 2 weeks or until the discharge stops. |
| |
| -Schedule an appointment for about a week after
your surgery. |
|
In addition, you may experience some of
the following:
| -Frequent urination during the first 24 hours;
this is normal. |
| |
| -A small amount of bloody, watery discharge for
up to 6 weeks following the procedure. It is impossible to evaluate the effectiveness
of your surgery until at least three months postoperatively. |
| |
| -Some cramping, for which your doctor may prescribe
or recommend pain medication. Many over-the-counter medications such as Motrin,
Aleve, Advil or Nuprin. |
| |
| -The anesthesia may cause mild nausea and vomiting.
|
Rarely, more serious problems such as cardiac arrest (heart stoppage) and pulmonary
arrest (no breathing) have been caused by general anesthesia.
Rarely, the viewing tube can puncture the uterus and injure the bowel. This
seldom happens, but if it does your physician will generally stop the procedure
and postpone it until the puncture heals by itself. Another possible risk is
fluid overload. If your body absorbs too much of the liquid used to fill up
your uterus during the operation, the procedure will be discontinued.
It is unlikely that the operating tool will puncture the thick uterine wall,
but this is a potential risk.
The bowel could also be damaged by heat from this tool. Infections developing
from either of these rare complications could require additional surgery.
Can I still get pregnant?
Probably not. Most women cannot have children after this procedure. Because
there is still a slight possibility of pregnancy, however, you should continue
to use contraception until you have entered menopause.
Endometrial ablation is a safe, effective alternative to hysterectomy. You
may also wish to learn more about another alternative, laparoscopic
assisted vaginal hysterectomy.
Some Medical Terms
Endometrial Ablation Removing the lining of
the womb. Removing the uterine lining will decrease your menstrual flow or even
stop it completely.
Endometrium (Uterine Lining) The cells that
line the womb. This tissue sheds in response to the hormonal changes of your
monthly period.
Electrosurgery Instead of a scalpel, a heat-generating
electrical device is used to burn-away, remove or vaporize tissue in this type
of procedure.
GnRH Analog This type of drug acts like a natural
hormone your body produces. It produces hormonal changes which decrease the
thickness of the endometrium.
Hysterectomy The surgical removal of the uterus.
Hysteroscopy A procedure used to see inside
the womb, using a viewing tube inserted into the vagina.
Laminaria A laminaria is a small rod-shaped
pieced of dried seaweed, that when placed in your cervix provides for more gentle
dilation of your cervix minimizing the risk of cervical tears.
Laparoscopic Assisted Vaginal Hysterectomy (LAVH)
A simpler form of hysterectomy (LAVH) used the laparoscope to avoid a large
abdominal incision.
Laparoscopy In this procedure, the physician
inserts a viewing tube through the skin to see inside the body. Other tubes
can be pushed through the skin to introduce probes or instruments; in this way
a number of surgical procedures can be performed without a large surgical incision.
Ultrasonography A procedure used to "see"
inside the body, using high-pitched sound waves. This is a little like radar
or sonar.
Uterus The womb.
Uterine Lining Sampling (Biopsy) In this procedure,
a small piece of tissue is removed from the lining of the womb and analyzed
in the lab.
