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October 24, 2017  
COMMUNITY: Frequently Asked Questions
Uterus1: What is endometrial ablation?
Dr. Craig deFreese: I usually tell people that they come to the hospital approximately two hours before the procedure and a nurse checks them in. The preparation is very simple. All they do is give them a gown, do paperwork with them, take their blood pressure, and go over or address any concerns that the patient has about surgery. They have one needle for blood work and one for an IV and that’s it. Then the anesthesiologist talks with them and reviews their medical history and any fears they have. I usually come along and talk to them to see how they feel and to answer any questions, and then we go into the operating room and that’s when they’ll get their general anesthetic. Once they’re asleep we do an exam, we look at the cervix, sometime we have to dilate the cervix manually with little dilators to insert the hysteroscope—a scope used to look inside the uterus. Everything is done through the cervix, so the person does not get any incisions or cuts at all. What we do is insert this. It’s connected to a camera so we watch the whole thing on a monitor, and we can visualize the inside of the uterine cavity and look for polyps or fibroids or anything that distorts the area, and pay special attention to that. We take pictures so we can show what it looked like before we do the procedure and after we do the procedure. What we do then is, according to the manufacturer’s protocol, we circulate a hot saline solution—it’s virtually 190 to 195 degrees Fahrenheit—inside the uterine cavity for about ten minutes. And what that does is essentially cooks and destroys the lining of the uterus. Many times, what we do is pre-treat the patient with a medication called lupron for about a month, that thins out the lining, and what that does is makes the procedure more effective. This is so that you’re more likely to have absolutely no periods afterwards or very minimal bleeding. What we do then is say, “complete the cycle, ” and the nice thing about this technique is that you can see all of this as you’re doing it. You know you’re visualizing it, you’re not just inserting an instrument in there blindly and either cauterizing the inside with electricity or using microwave or anything like that, so I feel safer doing that. The other nice thing is that you can treat the patient more thoroughly, since what you’re circulating in there is saline, which is essentially made up of water and salt. Water is obviously a very small molecule and it can get in every little crack and crevice that it has to. This is opposed to putting a balloon in, which of course is not going to have contact with every single part of the uterine cavity—because you can’t make a balloon that fits everybody. There’s another technique that’s called the NovaSure® where they put this netting in the uterine cavity. They expand it, and you kind of have to work it around one way or the other. Again, it doesn’t have contact with every single part of the uterine lining. Then what we do is cool the fluid off, because this is very hot and we wouldn’t want that to burn the patient coming out, so we wait until the machine cools it off and then we take our final pictures. We then remove the scope. The patient wakes up, goes to the recovery room for about an hour and then goes to the extended recovery area for about two hours, and then she goes home. Most people afterwards have minimal pain. Once in a while someone will need a narcotic, but most people do just great with either Tylenol or ibuprofen. Most people have just a little bit of a watery-bloody discharge for just a week or two, but it is rare to have somebody call us up and say this stuff is really heavy, when is this gonna be over with—I mean it just doesn’t happen. With some of the older techniques that we used to do years ago—it was called roller ball ablation, some of the older techniques—you had more complications and you had more bleeding afterwards. It was just more problematic for people.
Dr. Ignacio Armas: What endometrial ablation does is it uses some sort of energy force to destroy the lining of the uterus. The options are electricity, heat from hot water, ultrasound, or microwave energy – whatever it is, it’s to create heat to destroy or ablate the lining of the uterus permanently. The hydrothermal ablation uses water at 300 degrees Fahrenheit. That is my preferred method. That is the method that works tremendously well for a much broader population with relatively no side effects.
Dr. Jay Berman: Endometrial ablation is a group of techniques to remove the lining of the uterus to reduce a patient’s bleeding to more normal levels or even to eliminate bleeding completely. The first successful method was published in 1981 by Dr. Goldwrath who was my mentor when I was a resident. There had been many methods tried in the preceding 75 to 100 years, none of which had been successful. But technology made this a practical method that could be applied with a hysteroscope without a major incision.
Dr. Craig deFreese: I usually tell people that they come to the hospital approximately two hours before the procedure and a nurse checks them in. The preparation is very simple. All they do is give them a gown, do paperwork with them, take their blood pressure, and go over or address any concerns that the patient has about surgery. They have one needle for blood work and one for an IV and that’s it. Then the anesthesiologist talks with them and reviews their medical history and any fears they have. I usually come along and talk to them to see how they feel and to answer any questions, and then we go into the operating room and that’s when they’ll get their general anesthetic. Once they’re asleep we do an exam, we look at the cervix, sometime we have to dilate the cervix manually with little dilators to insert the hysteroscope—a scope used to look inside the uterus. Everything is done through the cervix, so the person does not get any incisions or cuts at all. What we do is insert this. It’s connected to a camera so we watch the whole thing on a monitor, and we can visualize the inside of the uterine cavity and look for polyps or fibroids or anything that distorts the area, and pay special attention to that. We take pictures so we can show what it looked like before we do the procedure and after we do the procedure. What we do then is, according to the manufacturer’s protocol, we circulate a hot saline solution—it’s virtually 190 to 195 degrees Fahrenheit—inside the uterine cavity for about ten minutes. And what that does is essentially cooks and destroys the lining of the uterus. Many times, what we do is pre-treat the patient with a medication called lupron for about a month, that thins out the lining, and what that does is makes the procedure more effective. This is so that you’re more likely to have absolutely no periods afterwards or very minimal bleeding. What we do then is say, “complete the cycle, ” and the nice thing about this technique is that you can see all of this as you’re doing it. You know you’re visualizing it, you’re not just inserting an instrument in there blindly and either cauterizing the inside with electricity or using microwave or anything like that, so I feel safer doing that. The other nice thing is that you can treat the patient more thoroughly, since what you’re circulating in there is saline, which is essentially made up of water and salt. Water is obviously a very small molecule and it can get in every little crack and crevice that it has to. This is opposed to putting a balloon in, which of course is not going to have contact with every single part of the uterine cavity—because you can’t make a balloon that fits everybody. There’s another technique that’s called the NovaSure® where they put this netting in the uterine cavity. They expand it, and you kind of have to work it around one way or the other. Again, it doesn’t have contact with every single part of the uterine lining. Then what we do is cool the fluid off, because this is very hot and we wouldn’t want that to burn the patient coming out, so we wait until the machine cools it off and then we take our final pictures. We then remove the scope. The patient wakes up, goes to the recovery room for about an hour and then goes to the extended recovery area for about two hours, and then she goes home. Most people afterwards have minimal pain. Once in a while someone will need a narcotic, but most people do just great with either Tylenol or ibuprofen. Most people have just a little bit of a watery-bloody discharge for just a week or two, but it is rare to have somebody call us up and say this stuff is really heavy, when is this gonna be over with—I mean it just doesn’t happen. With some of the older techniques that we used to do years ago—it was called roller ball ablation, some of the older techniques—you had more complications and you had more bleeding afterwards. It was just more problematic for people.
Dr. Ignacio Armas: What endometrial ablation does is it uses some sort of energy force to destroy the lining of the uterus. The options are electricity, heat from hot water, ultrasound, or microwave energy – whatever it is, it’s to create heat to destroy or ablate the lining of the uterus permanently. The hydrothermal ablation uses water at 300 degrees Fahrenheit. That is my preferred method. That is the method that works tremendously well for a much broader population with relatively no side effects.
Dr. Jay Berman: Endometrial ablation is a group of techniques to remove the lining of the uterus to reduce a patient’s bleeding to more normal levels or even to eliminate bleeding completely. The first successful method was published in 1981 by Dr. Goldwrath who was my mentor when I was a resident. There had been many methods tried in the preceding 75 to 100 years, none of which had been successful. But technology made this a practical method that could be applied with a hysteroscope without a major incision.
Dr. Craig deFreese

Dr. Craig deFreese


Dr. Craig DeFreese is an obstetrician/gynecologist who practices in Altamonte Springs, Orlando, Florida. He started his practice, Devoted to Women, about eight years ago, but has been caring for female patients for more than 19 years. Noting a growing trend in women’s preference for midwives, Dr. DeFreese now shares his office with a nurse midwife who delivers babies for many of his patients.

Dr. Ignacio Armas

Dr. Ignacio Armas


Dr. Ignacio Armas was born in Cuba and moved to the United States with his family when he was 10 years old. He attended medical school at the University of South Florida and currently practices Obstetrics and Gynecology in Brandon and Plant City, Florida. While practicing medicine for over 20 years, Dr. Armas has witnessed many changes in his field. He credits the use of minimally-invasive surgery, the practice of preventative medicine and cancer screening for improving the quality of women’s lives today. Dr. Armas has a special interest in laparoscopic surgery, menopause management and pediatric and adolescent gynecology. He is an advocate of patient education, and he regularly speaks in the community about natural hormone replacement and alternatives to hysterectomy.

Dr. Jay Berman

Dr. Jay Berman


Dr. Jay M. Berman is Assistant Professor of Gynecology at Wayne State University School of Medicine. He is in private practice in general and clinical gynecology. Actively involved in research, Dr. Berman is principal or co-investigator for several ongoing trials. His main area of interest is in operative laparoscopy, operative hysteroscopy including endometrial ablation and hysteroscopic sterilization, colposcopy, lower genital tract disease and laser surgery. He is also the principal investigator for an ongoing animal laboratory for training residents in laparoscopic surgery.

Dr. Craig deFreese

Dr. Craig deFreese


Dr. Craig DeFreese is an obstetrician/gynecologist who practices in Altamonte Springs, Orlando, Florida. He started his practice, Devoted to Women, about eight years ago, but has been caring for female patients for more than 19 years. Noting a growing trend in women’s preference for midwives, Dr. DeFreese now shares his office with a nurse midwife who delivers babies for many of his patients.

Dr. Ignacio Armas

Dr. Ignacio Armas


Dr. Ignacio Armas was born in Cuba and moved to the United States with his family when he was 10 years old. He attended medical school at the University of South Florida and currently practices Obstetrics and Gynecology in Brandon and Plant City, Florida. While practicing medicine for over 20 years, Dr. Armas has witnessed many changes in his field. He credits the use of minimally-invasive surgery, the practice of preventative medicine and cancer screening for improving the quality of women’s lives today. Dr. Armas has a special interest in laparoscopic surgery, menopause management and pediatric and adolescent gynecology. He is an advocate of patient education, and he regularly speaks in the community about natural hormone replacement and alternatives to hysterectomy.

Dr. Jay Berman

Dr. Jay Berman


Dr. Jay M. Berman is Assistant Professor of Gynecology at Wayne State University School of Medicine. He is in private practice in general and clinical gynecology. Actively involved in research, Dr. Berman is principal or co-investigator for several ongoing trials. His main area of interest is in operative laparoscopy, operative hysteroscopy including endometrial ablation and hysteroscopic sterilization, colposcopy, lower genital tract disease and laser surgery. He is also the principal investigator for an ongoing animal laboratory for training residents in laparoscopic surgery.

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