Endometrial Ablation

Women with menorrhagia who do not wish to have children and for whom medical therapy has not provided relief from their heavy bleeding may be candidates for a procedure called endometrial ablation, which stops or reduces heavy bleeding by destroying the lining of the uterus.  The procedure is minimally invasive, which means that it can be done on an outpatient basis or even in the gynecologist’s office if the doctor has the appropriate training and equipment to perform it.

Different approaches may use electricity, heat or freezing to destroy the uterine lining.  Studies have shown that over 90% of women who have had endometrial ablation experience relief from their heavy periods.  Furthermore, because it is minimally invasive, endometrial ablation avoids the costs and risks of hysterectomy, and patients are able to be back to their normal routines within a day or two.

There are some women for whom this procedure does not work, and these women may require additional surgeries or even hysterectomy.  The success of endometrial ablation as compared to hysterectomy for menorrhagia was compared recently in a large study conducted in both U.S. and Canadian clinical centers.  The researchers concluded that endometrial ablation provides satisfactory control of abnormal uterine bleeding for the majority of women, with many fewer complications than hysterectomy.  However, about 31% of those who had endometrial ablation had a return of their symptoms within 5 years and ultimately elected to have a hysterectomy.  Other studies have shown better results.

In addition, there are cases of menorrhagia for which endometrial ablation is not appropriate.  For example, if menorrhagia was caused by fibroids, other treatment approaches are more likely to be successful and safe.

The procedure is not reliable as a sterilization, but pregnancy afterwards is rare since the uterine lining has been (mostly) destroyed.

Once the uterine lining (endometrium) has been destroyed, pregnancy is extremely risky. If only a few cells remain where the fetus may attach, it is likely that the placenta would develop abnormally and cause miscarriage or hemorrhage at the time of delivery. Thus, endometrial ablation is recommended only for women who are quite sure they no longer wish to have children.

References

1. ACOG Committee on Practice Bulletins – Gynecology. ACOG Practice Bulletin: management of anovulatory bleeding. Intl J Gynaecol Obstet. 2001;72(3):263-71.
2. American Society for Reproductive Medicine. Patient’s Fact Sheet: Endometrial Ablation. 2001. www.asrm.org/Patients/FactSheets/Endoablation.pdf.
3. Lethaby A, et al. Endometrial destruction techniques for heavy menstrual bleeding. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001501
4. Lewin Group, Inc. Prevalence and treatment patterns of pelvic health disorders among U.S. women. National Women’s Health Resource Center 2007. www.healthywomen.org.
5. McCausland AM, et al. Long-term complications of endometrial ablation: Cause, diagnosis, treatment, and prevention. J Min Invasive Gyn. 2007;14:399-406.
6. Munro MG, et al. A randomized trial of hysterectomy versus endometrial ablation: Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB). Abstr. J Minimally Invasive Gynecol. 2006;13(5):S69.
7. Munro M. Abnormal uterine bleeding in the reproductive years. Part III: Surgical management. J Am Assoc Gynecologic Laparoscopists. 8:18-48.
8. Parker WH. A Gynecologist’s Second Opinion. 2003; A Plume Book; Published by the Penguin Group, New York, NY.