Endometrial Ablation Treatment for Heavy Menses

Heavy uterine bleeding (menorrhagia) is a common problem with a variety of causes. Heavy Menses may be due to hormonal disturbances, uterine fibroids, polyps, overgrowth of the uterine lining (hyperplasia), or cancer. Medical conditions, such as bleeding disorders or thyroid disease, may also contribute. If a specific cause for abnormal bleeding is identified, treatment should be directed toward that cause.

If no specific anatomical cause is identified or if hormonal disturbances do not improve with hormone therapy, endometrial ablation (destruction of the uterine lining) may be an alternative to hysterectomy. As both endometrial ablation and hysterectomy preclude further childbearing, they should not be considered by patients who wish to retain their fertility. A biopsy of the uterine lining may be needed to exclude cancer, since endometrial ablation is never appropriate if cancer is suspected.

A Variety of Techniques for Endometrial Ablation Procedures

Freezing of the Uterine Lining (performed in our office)

Another technique used to destroy the endometrium is freezing the uterine lining. There is no evidence that one method produces superior success rates, and a variety of new techniques (phototherapy, microwave, radio-frequency) are under development.

This technique is performed in an outpatient surgical center or in a doctor’s office. A triangular balloon is placed into the uterus and filled with fluid. The fluid in the balloon is then heated for several minutes. During this time, most of the uterine lining is destroyed. Cramping may be severe during the procedure, and either general or local anesthesia is normally required. Ibuprofen or similar medications are usually effective for postoperative pain. Short-term results with balloon endometrial ablation are comparable to electrosurgical methods.

Complications
Complications from endometrial ablation procedures are few, but may be serious. Uterine perforation (puncturing a hole in the uterus) may occur and may result in hemorrhage or bowel injury. Additionally, electrosurgery requires fluid to be instilled in the uterine cavity which can lead to fluid overload.
Women who have undergone endometrial ablation should be treated with progestogens to reduce the risk of developing uterine cancer when postmenopausal estrogen replacement therapy is prescribed.

Women who have undergone hysterectomy, in contrast, generally do not require progestogens.

This information is provided by The American Society for Reproductive Medicine.

This information is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, or have any questions, please contact your obstetrician-gynecologist.