You may decide to have endometrial ablation if you have heavy or long periods. You may also have it for bleeding between periods abnormal uterine bleeding. In some cases, the bleeding may be so heavy that it affects your daily activities and causes a low blood count anemia because of it. Heavy bleeding is described as bleeding that requires changing sanitary pads or tampons every hour.
Long periods are described as lasting longer than 7 days. Menstrual bleeding problems may be caused by hormone problems. This is especially true for women nearing menopause or after menopause.
Other causes include abnormal tissues such as fibroids, polyps, or cancer of the endometrium or uterus. Endometrial ablation lessens menstrual bleeding or stops it completely.
You may not be able to get pregnant after endometrial ablation. This is because the endometrial lining, where the egg implants after being fertilized, has been removed.
Pregnancies that occur after an endometrial ablation are not normal, therefore it is important to use a reliable form of birth control. You will still have your reproductive organs. You may have other risks based on your condition.
Be sure to discuss any concerns with your healthcare provider before the procedure. You may have an endometrial ablation in your healthcare provider's office, as an outpatient, or during a hospital stay.
The way the test is done may vary depending on your condition and your healthcare provider's practices. The type of anesthesia will depend on the procedure being done. It may be done while you are asleep under general anesthesia. Or it may be done while you are awake under spinal or epidural anesthesia.
If spinal or epidural anesthesia is used, you will have no feeling from your waist down. The anesthesiologist will watch your heart rate, blood pressure, breathing, and blood oxygen level during the procedure. The recovery process will vary, depending on what type of ablation you had and the type of anesthesia used. If you had spinal, epidural or general anesthesia, you will be taken to the recovery room. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or sent home.
If you had the procedure as an outpatient, plan to have someone else drive you home. You may want to wear a sanitary pad for bleeding. It is normal to have vaginal bleeding for a few days after the procedure. You may also have a watery-bloody discharge for several weeks. You may have strong cramping, nausea, vomiting, or the need to urinate often for the first few days after the procedure. Cramping may continue for a longer time. Do not to douche, use tampons, or have sex for 2 to 3 days after an endometrial ablation, or as advised by your health care provider.
You may also have other limits on your activity. These may include no strenuous activity or heavy lifting. Take a pain reliever for cramping or soreness as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding and should not be taken. Be sure to take only recommended medicines. Your healthcare provider may give you other instructions after the procedure, based on your situation. Talk with your healthcare provider about appropriate types of birth control for you.
Health Home Treatments, Tests and Therapies. He or she can use: Electricity electrical or electrocautery. In this method, your provider uses an electric current that travels through a wire loop or roller ball. The current is put on the uterus lining to destroy it. Fluids hydrothermal. This method uses heated fluid. It is pumped into the uterus to destroy the lining. Balloon therapy. In some women, menstrual flow may stop completely.
No incisions are needed for endometrial ablation. Your doctor inserts slender tools through the passageway between your vagina and uterus cervix.
The tools vary, depending on the method used to ablate the endometrium. Methods might include extreme cold, heated fluids, microwave energy or high-energy radiofrequencies. Some types of endometrial ablation can be done in your doctor's office. Others must be performed in an operating room. Factors such as the size and condition of your uterus will help determine which endometrial ablation method is most appropriate. Endometrial ablation is a treatment for excessive menstrual blood loss.
Your doctor might recommend endometrial ablation if you have:. To reduce menstrual bleeding, doctors generally start by prescribing medications or an intrauterine device IUD. Endometrial ablation might be an option if these other treatments don't help or if you're not able to have other therapies. Pregnancy can occur after endometrial ablation. However, these pregnancies might be higher risk to mother and baby.
The pregnancy might end in miscarriage because the lining of the uterus has been damaged, or the pregnancy might occur in the fallopian tubes or cervix instead of the uterus ectopic pregnancy. Some types of sterilization procedures can be done at the time of endometrial ablation. If you are having endometrial ablation, long-lasting contraception or sterilization is recommended to prevent pregnancy. One type of endometrial ablation uses a thermal balloon filled with heated fluid to destroy the lining of the uterus endometrium.
During radiofrequency ablation, your doctor uses a triangular ablation device which transmits radiofrequency energy and destroys the tissue lining the uterus endometrium. The ablation device is then removed from the uterus. Endometrial ablation can be performed in your doctor's office.
But some types of endometrial ablation are performed in a hospital, especially if you will need general anesthesia. The opening in your cervix needs to be widened dilated to allow for the passage of the instruments used in endometrial ablation.
Dilation of your cervix can happen with medication or the insertion of a series of rods that gradually increase in diameter. Endometrial ablation procedures vary by the method used to remove or destroy the endometrium. If those less satisfied opt out of answering, this may mask a difference in patient reported satisfaction between the different procedures. Similarly if those opting out have a higher rate of failure need of further treatment this may also mask a reported difference between the two methods, although for the participating women we do not find any difference regarding satisfaction or subsequent hysterectomy.
We have tried to evaluate the impact of relevant confounding factors: age, menopausal status, sterilization status, endometrial thickness, presence of myomas and surgeon experience by performing multivariate logistic regression analysis. Of these factors only higher age independently decreased risk of subsequent hysterectomy while women treated by surgeons of moderate to high experience somewhat surprisingly had a higher rate of further surgery.
The strength of our study is the relatively large patient cohorts regarding the total number of hysteroscopic resections and endometrial ablations, and a long follow-up including patient reported outcomes performed similarly in two different time-periods.
Surgeons were not specifically assigned to participate in this study when performing the procedures. Therefore, our findings reflect a success- and complication rate to be expected in everyday surgical practice.
Our study includes outcome in relation to surgeon experience and highlights the fact that less surgical experience has no impact on complication or satisfaction rate for non-hysteroscopic endometrial ablation. The validity of our study is considered to extend at least to the other Nordic countries, as the populations and the quality of health services are similar. All together, we consider that our findings are clinically meaningful and may have direct implication on surgical practice.
Thus, complementing hysteroscopic treatment for abnormal bleeding by an endometrial ablation procedure has been evaluated as beneficial in a routine clinical setting. After introduction of endometrial ablation as a supplement to hysteroscopic resection, the complication rate and operation time in our department has declined, compared with a previous cohort of hysteroscopic resection. Although demanding less surgeon experience, the patient reported outcomes were slightly better and the subsequent hysterectomy rate non-inferior for patients operated during — when endometrial ablation was part of routine treatment for abnormal uterine bleeding.
When medical treatment is not feasible, endometrial ablation may be a good alternative to hysteroscopic resection in properly selected patients.
Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background Abnormal uterine bleeding needs surgical treatment if medical therapy fails. Materials and methods Historical cohort study of women treated for abnormal uterine bleeding with hysteroscopic resection or endometrial ablation at Haukeland University Hospital during — Conclusions Endometrial ablation has similar patient satisfaction rate, but shorter operation time and lower complication rate and may be a good alternative to hysteroscopic resection for treatment of abnormal uterine bleeding.
Funding: The authors received no specific funding for this work. Materials and methods In this historical cohort study patients were identified from the electronic patient files from Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway. Download: PPT. Table 1. Preoperative clinical characteristics for women treated for abnormal menstrual bleeding.
Table 2. Perioperative data for women treated with hysteroscopic resection or endometrial ablation during — Table 3. Patient self-reported clinical characteristics after surgery for abnormal uterine bleeding during — Fig 2.
Survival curves displaying rate of subsequent hysterectomy. Table 4. Preoperative clinical characteristics for women treated for abnormal menstrual bleeding during two time periods. Table 5. Perioperative data for women treated by minimal invasive procedures during two time cohorts. Table 6. Patient self-reported clinical characteristics after surgery for abnormal uterine bleeding, comparison of two cohorts. Table 7. Prediction of risk of subsequent hysterectomy after minimal invasion surgery for bleeding disorders.
Discussion Comparing the two time cohorts including women treated with minimally invasive procedures for abnormal uterine bleeding, we found a stable subsequent hysterectomy rate and a slightly improved patient-reported satisfaction rate. Conclusions After introduction of endometrial ablation as a supplement to hysteroscopic resection, the complication rate and operation time in our department has declined, compared with a previous cohort of hysteroscopic resection.
Supporting information. S1 Fig. Patient-reported questionnaire, Norwegian. Norwegian version original of questionnaire used. S2 Fig. Patient-reported questionnaire, English. English translation of questionnaire used. S1 Table.
Prediction of patient self-reporting overall satisfaction with minimal invasion surgery for bleeding disorders. Acknowledgments We are thankful for all women accepting to participate and answering the questionnaire. References 1. Incidence and treatment of heavy menstrual bleeding in general practice.
Fam Pract. Incidence and burden of gynecologic disorders, active component service women, U. Armed Forces, — Menstrual blood loss-a population study. Variation at different ages and attempts to define normality.
Acta obstetricia et gynecologica Scandinavica. Effects of anemia and iron deficiency on quality of life in women with heavy menstrual bleeding. Surgery versus medical therapy for heavy menstrual bleeding.
The Cochrane database of systematic reviews. Medical therapy versus radiofrequency endometrial ablation in the initial treatment of heavy menstrual bleeding iTOM Trial : A clinical and economic analysis. PLoS One. Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. View Article Google Scholar 8.
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