Index
It is the surgical destruction of the lining tissues of the uterus, known as the endometrium.
Endometrial ablation is a type of treatment for abnormal uterine bleeding.
Indications
Endometrial ablation is a treatment for abnormal bleeding of the uterus that is due to a benign (noncancerous) condition.
It is not a sufficient treatment when bleeding is caused by cancer of the uterus, since cancer cells may have grown into the deeper tissues of the uterus and often can not be removed by the procedure.
Endometrial ablation is only done in a non-pregnant woman who does not plan to become pregnant in the future.
It should not be done if the woman has an active infection of the genital tract. This treatment is not a first-line therapy for heavy bleeding and should only be considered when medical and hormonal therapies have not been sufficient to control bleeding.
Process
Before the procedure, a woman needs an endometrial sampling (biopsy) to exclude the presence of cancer.
Imaging and / or direct visualization with a hysteroscope (an illuminated visualization instrument that is inserted to visualize the inside of the uterus) are necessary to exclude the presence of uterine polyps or benign tumors (fibroids) beneath the lining tissues of the uterus. uterus.
Polyps and fibroids are possible causes of heavy bleeding that can be eliminated in a simple manner without ablation of the entire endometrium. Obviously, the possibility of pregnancy should be excluded and intrauterine contraceptive devices (IUDs) should be removed before endometrial ablation.
Hormone therapy can be given in the weeks before the procedure (especially in younger women), in order to reduce the size of the endometrium to a point where ablation therapy has the greatest chance of success.
The belief is that the thinner the endometrium is, the greater the chances of successful ablation.
To begin the procedure, the cervical opening dilates to allow the passage of the instruments into the uterine cavity. Different procedures have been used and all are equally effective in destroying the tissue of the uterine lining. These include lasers, electricity, freezing and heating.
The choice of procedure depends on a number of factors, including:
- The preference and experience of the surgeon.
- The presence of fibroids, the size and shape of the uterus.
- Whether or not medication is administered prior to the treatment and the type of anesthesia desired by the patient.
- The type of anesthesia required depends on the method used, and some procedures of endometrial ablation can be performed with minimal anesthesia during an office visit. Others can be performed in an ambulatory surgery center.
What are the risks and complications?
- Accidental drilling of the uterus.
- Tears or damage to the cervical opening (the opening to the uterus).
- Infection, bleeding and burns in the uterus or intestines.
In very rare cases, the fluid used to expand the uterus during the procedure can be absorbed into the bloodstream, leading to the presence of fluid in the lungs ( pulmonary edema ).
Some women may experience a new growth of the endometrium and need more surgery.
Minor side effects of the procedure can occur for a few days, including cramping (such as menstrual cramps), nausea, and frequent urination that can last for 24 hours.
An aqueous discharge mixed with blood may be present for a few weeks after the procedure and may be heavy during the first few days.
Forecast
The majority of women who undergo endometrial ablation report a successful reduction of abnormal bleeding.
Up to half of women will stop having periods after the procedure. However, studies indicate that the failure rate (defined as hemorrhage or pain after endometrial ablation that required hysterectomy or resorption) was 16% to 30% at 5 years.
Failure was most likely in women younger than 45 years and in women with 5 or more children, previous tubal ligation and a history of painful menstrual cramps.
After endometrial ablation, 11% to 36% of women had repeated ablation or another procedure of uterine preservation.
Although the procedure removes the lining of the uterus and typically produces infertility, it should not be considered a measure of birth control, because pregnancy can still occur in a small portion of the endometrium that remains or has regrown.
In this case, there can be serious problems with the pregnancy, and the procedure should never be performed if the woman may want the pregnancy in the future.
