Don't lose your "U" just because of heavy periods!! Ablation info here!
So just because you have heavy periods, doesn’t mean you have to have a hysterectomy ladies! One option is an endometrial ablation. So what is an endometrial ablation and should you jump on the “no period” train?
Endometrial ablation is a procedure that involves destroying the endometrial lining within the uterus usually by a “burning” method to prevent heavy periods. Many women have such a good result that they can end up literally with no period! Ultimately this becomes a way for a woman not to necessarily lose her “U” or “uterus” by means of a hysterectomy!
It is estimated that heavy menstrual cycles affect 1 in 5 women. I literally see at least 2-3 patients a day with this annoying problem. We discuss options of birth control pills, a levonorgestrel containing IUD, endometrial ablation, removal of fibroids or ultimately a hysterectomy if that what a woman desires. The endometrial ablation though is a nice option because it can take care of the problem without requiring much downtime, no hormones are involved, and usually less risk than major surgery.
Now, with that being said it depends on the cause of your heavy bleeding to make the ablation an option for you. The most common reasons for abnormal uterine bleeding are of course hormonal imbalances, uterine polyps or fibroids, infections, bleeding disorders, and uterine cancer.
Now usually the preparation or work-up to see if you are a candidate for an ablation includes a transvaginal ultrasound and an endometrial biopsy to rule out endometrial hyperplasia or cancer, since we don’t want to ablate abnormal tissue. I also take into account your age, whether or not you still desire pregnancy in the future and if you have a permanent form of contraception or not. I also review how many cesareans you have had and what type of scar you were given, because this can make your uterine wall weak and increase your risk of complications.
This procedure is only for premenopausal women. Postmenopausal women should not be bleeding, therefore an ablation not a treatment option for postmenopausal bleeding and it should be evaluated. I find that doing this procedure in your late 30s to late 40s is a good age to get a good result. Not always, but if you do it too young, I find those women can end up with heavy bleeding again and it is usually about 50% within 5 years of the ablation. So you might be good for several years, but many women do experience problems again down the road. It is not recommended to repeat an ablation, so in this case either control of heavy menses with birth control pills, Depo-Provera injections or hysterectomy is necessary. I know those aren’t the most appealing options, that’s why you have to make an informed decision when you get this done at a young age.
It is also important to remember this is not a form of birth control! I have seen patients get pregnant after ablation and have complications with their pregnancies. So it is recommended to have your tubes tied or your partner have a vasectomy, but if you end up with a new partner and he doesn’t have a vasectomy, then you need to discuss your options with your doctor.
One warning I would give you though, if you have PCOS, are obese or are at risk for uterine cancer based on your family history, I would not recommend an ablation because you can have precancerous cells or cancerous cells growing inside your uterus and this could be harder to detect since the ablation can make obtaining a biopsy after the procedure more difficult and therefore delay a diagnosis of cancer!
Depending on your medical history and if you already have a permanent form of sterilization, this procedure can sometimes but done in the office with or without sedation. I do most of my ablations with sedation just so the patient is more comfortable, but I know some physicians who have been successful with protocols with local anesthesia only and patient doing well.
Risks with the procedure are rare but include uterine perforation which is when an opening is made inside the uterine wall, bleeding, infection, injury to bladder or bowel and potential of inability to correct your heavy bleeding.
After your procedure, most women return to normal activities the next day. You can experience light to heavy bleeding as your uterus heals for up to a couple of months. Usually, after two months, the amount of bleeding you experience or don’t experience will likely be what to expect for your future periods. In some trials, most women are up to 98% satisfied with their periods after the ablation.
Ultimately, if your heavy periods are from fibroids, you don’t have to lose your “U” because of these things either. A uterine artery embolization or the new Acessa procedure which both help to shrink fibroids in different ways are technologies that are now available. We will discuss later!
Knowing all this, I hope you can better decide if you are a candidate for an endometrial ablation!
Dr. E
“The secret: Make every minute count.”