Endometrial ablation is a surgical procedure used to treat women suffering from excessive or prolonged menstrual bleeding and who have not responded to other treatments such as medication. Endometrial ablation removes or destroys the uterine lining, or endometrium, while leaving the ovaries and uterus intact. The endometrium heals by scarring, which reduces or stops future uterine bleeding.
Types of Endometrial Ablation
There are several different methods of endometrial ablation.Most methods are performed under local or general anesthesia and a hysterscopy to examine the uterine area is commonly performed prior to the endometrial ablation procedure. Common methods of endometrial ablation may include:
Hydrothermal Endometrial Ablation
Hydrothermal endometrial ablation or HTA, uses heated water to destroy the lining of the uterus.Water is heated to 194 degrees and directed into the uterus using a pump device. The water is flushed through the uterus, carefully monitored at all times to ensure it does not enter the fallopian tubes, and drained after approximately 10 minutes.
Microwave Energy Endometrial Ablation
With microwave energy endometrial ablation, a probe is inserted into the uterus through the cervix and it applies microwave energy to the uterine lining, which destroys it.
Freezing Endometrial Ablation
A thin probe is inserted through the cervix and the end of the probe freezes the uterine lining.
Radio Frequency Endometrial Ablation
A probe is inserted through the cervix that emits radio frequency and heat which destroy the uterine lining. Suction is used to remove the destroyed tissue.
After some of the treatments that do not use suction to remove the destroyed tissue, the treated endometrial lining will naturally break down as it would during a typical menstrual period within a few weeks.
Recovery from Endometrial Ablation
After endometrial ablation, most patients experience cramping for up to two days and a watery discharge that may last a few weeks. Most normal activities may be resumed the following day, with the exception of tampon use and sexual activity.
Risks of Endometrial Ablation
Although it is considered a common and safe procedure, there are risks of endometrial ablation which may include:
- Burns to the vagina, vulva or bowel when using methods that use heat
- Fluid entering the bloodstream
Patients should discuss all risks with their doctor before deciding whether endometrial ablation is the right treatment for their condition.
Loop electrosurgical excision procedure (LEEP) is used to treat abnormal cells found on the surface of the cervix. During the procedure, the abnormal cells are removed to prevent development of cervical cancer.
Wire loops attached to an electrosurgical generator cut away the affected tissue, causing the cells to heat and burst. The tissue removed is sent to a lab for further evaluation, including ensuring that the abnormal area has been fully removed. An assessment as to the cause of the growth of abnormal tissue will also be done. The LEEP procedure takes 20-30 minutes and can be performed in the office. A local anesthetic is administered to minimize pain.
Urinary incontinence is defined as the involuntary loss of urine and has been shown to affect a person's social, clinical, and psychological well-being. Urinary incontinence has been reported to affect about one in four women, less than half of which seek medical care. Stress Incontinence is the involuntary loss of urine during physical activity. One of the causes of stress incontinence is the loss of anatomic support of the bladder which may be the result of pregnancy and vaginal delivery or due to tissue atrophy that results from advancing age. Urge Incontinence is the involuntary loss of urine associated with an abrupt and strong desire to void (urgency). Mixed incontinence is a combination of both stress and urge incontinence, and is most common in older women.
Urodynamic testing provides valuable data on bladder function for your physician to make the best recommendations for treatment. This study does not require sedating medication and usually takes between 15-30 minutes. We ask that you arrive at the office with a full bladder and try to avoid emptying your bladder until instructed to do so. Several different tests are used to evaluate symptoms of the lower urinary tract. Because of your particular symptoms and concerns, tests which you can expect to be performed at your appointment include uroflowmetry, cystometry, urethral pressure profile study, and pressure flow study.