Endometrial Ablation

Endometrial ablation (EA) involves removing the lining of a woman’s uterus. EA is an alternative to hysterectomy for women who have excessive menstrual or uterine bleeding. Ablation procedures can prevent the need for 80%-90% of currently performed hysterectomies based on extensive review of the published literature. In contrast to a hysterectomy (removal of the uterus), an ablation procedure is performed either in your gynecologist’s office or as an outpatient surgery, with patient’s returning home the same day, and without the need for an abdominal or vaginal incision.
Types of Endometrial Ablation
The original ablation procedure involved the use of an argon laser, but was time-consuming and expensive to perform, and required great surgical skill. In 1990, RollerBarrell ablation was introduced, which was easier to perform and required less complex and less costly surgical equipment. However, an experienced gynecologic endoscopic surgeon is required. These are called “First Generation EA techniques”.

“Second Generation Endometrial Ablation devices”, or “SEAT” for short, have now been developed and are available in the United States. Benefits of SEAT procedures are that they are easier to perform, easier to learn by physicians, have very high success rates, are safer than first generation devices, and in contrast to first generation devices, many SEAT’s can be performed in your doctor’s office, taking only 15 minutes, and not requiring major anesthesia. These second generation devices use various methods for destroying the endometrial cavity, including radio frequency, electrical energy, lasers, hot water and freezing. Suppression of endometrial development prior to EA may or may not be required, depending on the type of SEAT device used.

Risks
Most potential complications of EA involve use of the First Generation devices. These include risks of anesthesia, uterine perforation, and absorption of large volumes of fluid used during the ablation procedure (fluid overload). Patient deaths have been reported from this latter complication.

The SEATs have the advantage of not using high volumes of, or dangerous fluids, requiring less anesthesia, requiring less time to complete, and in many cases, being able to perform these in your gynecologist’s office rather than a hospital or surgi-center.

Procedure
With most first and second generation EA devices, the menstrual cycle may need to be modified before the ablation procedure. Your doctor may recommend suppression of ovarian hormones and the uterine lining using a GnRH analogue such as Lupron, Synarel, Antagon or other similar medication. These medications are expensive however, and one of the second generation EA devices (NovaSure) does not require any pretreatment of a woman’s endometrium. Another technique is to specifically time the EA procedure so that is can be performed immediately following a menstrual period. This is, however, usually difficult to schedule because the patient, physician, and operating room facility (or office) will all have to be available on very short notice.

Recovery
Most women have a brownish to bloody vaginal discharge for up to 6 weeks following EA. Avoid strenuous activities or exercise for two weeks, to minimize excess bleeding. In contrast to a hysterectomy, which may require up to 8 weeks for recovery, most women who have EA are able to return to most normal activities within 2-3 days. EA may prevent future pregnancy, but it should not be considered a sterilization technique, and other method(s) of contraception should be used by women who wish to avoid pregnancy.

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