Uterus1

Endometrial Ablation

Overview
Reviewed by Richard Alweis, MD

Endometrial ablation is the name of a procedure that removes a thin layer of the uterine lining, or endometrium, and it is often used to treat patients who have menstrual problems, such as unusually heavy or painful periods, or suffer from excessive uterine bleeding for other reasons.
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This treatment often presents a preferable alternative to hysterectomy (surgical removal of the uterus) for patients whose periods continue to be excessive or prolonged to the point of interfering with day-to-day life, and for whom other treatments have not worked.

Detailed Description
For a few weeks before the procedure, a patient is often given medication, either in pill form or via injection, which helps to decrease the thickness of the endometrium. The procedure itself usually takes less than an hour, and can be conducted on an outpatient basis, since it does not require surgical incisions.

At the beginning of the procedure, the patient is given general anesthesia, and then a small telescope-like device called a hysteroscope is inserted into the uterus through the cervix, to help doctors see the area they are treating. The uterus is then filled with a harmless saline solution, and a heat-generating device is used to burn away or vaporize the lining of the uterus. After the procedure, doctors wait for the anesthesia to wear off, and then the patient can be sent home. Some newer techniques of endometrial ablation do not require general anesthesia, and are done using a larger range of agents to remove the endometrium, such as radio frequency, electrical currents, lasers, and hot saline.

In the day or so following the procedure, patients may experience frequent urination, cramping, and bloody discharge. The cramping can usually be alleviated with the help of an over the counter pain medication, such as Advil or Motrin, and the frequent urination should end without medical intervention. Patients are advised to refrain from strenuous activity for the day following the procedure, and to refrain from sexual intercourse for up to six weeks, or for as long as any bloody discharge continues.

Women who undergo endometrial ablation will no longer be able to have children, and typically experience a slowing or stopping of their menstrual flow after recovery. However, for those who do not wish to have children but for emotional or medical reasons do not want to undergo hysterectomy, endometrial ablation provides a safe and far less invasive treatment for excessive menstrual bleeding, with less in-hospital recovery time and few noticeable post-procedure complications.

Second Generation Ablation Devices

Endometrial Ablation Using Hot Saline - This technique allows the gynecologist to perform endometrial ablation on an outpatient basis. In this 10-minute procedure, the doctor administers a local anesthetic and then inserts a hysteroscope into the patient’s uterus in order to view the uterine lining. Heated saline is then circulated to destroy the lining of the uterus. The technology used in this procedure is HTA System.

Balloon Ablation - This procedure consists of the gynecologist placing a soft, flexible balloon attached to a catheter into the uterus. Fluid is then inserted into the balloon so that the balloon inflates and conforms to fit the uterus. The fluid is heated by a probe inside the balloon and treats the uterine lining by circulating within the balloon for eight minutes. Once treatment is completed, the gynecologist withdraws first the fluid and then the actual balloon from the uterus.

Bipolar Ablation - Another ablation option, this procedure consists of the gynecologist placing a triangular mesh-like device through a wand that is inserted into the uterus. The device is then expanded to fit the uterus and electrical energy is passed through the wand into the uterus to treat the uterine lining. The energy is delivered through the wand, and upon completion, the device and wand are then withdrawn from the uterus.

Cryoblation – Unlike the other heat-based ablation procedures described, cryoblation uses a freezing technique to treat the uterus. After administering local anesthesia, a probe is inserted into the uterus by the gynecologist. Using ultrasound as a guide, the physician uses the probe to begin freezing tissue symmetrically around its tip, destroying the uterine lining.

Endometrial Ablation With Laser – Similar to the standard endometrial ablation procedure described above, endometrial laser intrauterine thermotherapy (ELITT) uses a laser to directly heat and treat the uterine lining without any addition fluid or devices.

Endometrial Ablation With Microwave – Also similar to the standard endometrial ablation procedure, microwave ablation uses low-power microwaves to treat the uterine lining.


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Last updated: 06-Jun-07