Endometrial Ablation

This service provided by the Reproductive Science Centerª of the San Francisco Bay Area

Over the past decade, techniques have been developed that now permit the reduction or cessation of menstruation without the necessity of hysterectomy. There are three methods available and generally require a general or regional (epidural or spinal) or local anesthesia.

The first method described, but seldom used anymore, is endometrial ablation using a Yag laser. A more commonly used technique involves the use of electric cautery to cauterize or destroy the endometrial tissue. In both cases, the tissue being destroyed is the lining of the endometrial cavity. Both techniques appear equally effective although the cautery technique is achieves a higher degree of success in the cessation of menses. Moreover, the cautery technique takes less time to perform.

The cautery technique is called "Rollerball" Endometrial Ablation. This technique has been used since 1990. During this period of time, patients have enjoyed either complete or almost complete cessation of menses in about 80 percent of cases. Rollerball is done under general anesthesia or regional block (spinal or epidural). This is an outpatient procedure, and hospitalization is not necessary except in rare instances. The safest form of rollerball ablation employs the use of a bipolar sleeve to avoid having to use solutions which can increase complication rates to the patient.

A more recent office-based technique for performing endometrial ablation involves the placement of an intrauterine balloon. The early balloon techniques only produced resolution of bleeding in about 30% of patients. A more effective balloon device is currently being tested and should be available in the year 2000; it has an 80-90% bleeding cessation rate (Novaceptª). Our center is one of 4 FDA investigative sites in the United States for this latest device.

Following the procedure, patients note a brownish to slightly bloody discharge which occurs shortly after the procedure and can last up to 6 weeks. Patients are advised to refrain from any kind of exercise for at least 3-4 weeks because there has been brisk, bright red bleeding following strenuous exercises (i.e., moving furniture, cutting wood, jogging). Half the patients will experience no side effects with the cautery technique and are back to full activity within 2-3 days; the other half will notice a cramp-like sensations and are tired for several days. Over 90 percent of the patients are back to full activity within 4-5 days following surgery. Most patient take 4-5 days off following their surgery, although some individuals have returned to work within 24 hours. This operation may cause sterility, but it is not guaranteed. However, if you choose to be permanently sterile, a tubal ligation should be performed.

Prior to using either cautery technique, it is important that the menstrual cycle be modified. This is achieved by taking an injection of a medication called Depot-Lupron. Lupron is a medication usually used for a condition called endometriosis. The temporary side effects of Lupron may include weight gain, acne, and hot flushes.

Following the cauterization of the uterine cavity, patients are given a shot of a long acting progesterone called Depo Provera, or an additional dose of Depot-Lupron. The shot will last 1-3 months. During this time, a rare patient may experience mild depression. Bleeding is generally reduced when this medication is used postoperatively.

In about 80% of women treated, there is either reduction or cessation of the menstrual flow. However, it takes 1 year to know exactly what the final results of treatment will be. The complications of cauterization of the uterine lining include the risks of anesthesia and perforation of the uterus. Also, there is a large volume of fluid utilized during the procedure and there is a rare chance of absorption of this fluid with mild alteration in blood products, i.e., electrolytes (this complication is virtually avoided by using a bipolar sleeve and normal saline for uterine distention). The risk of perforation of the uterus is rare primarily because of the modifications that we now employ in performing the technique.

All methods are generally safe when performed by gynecologists who are specially trained and experienced in advanced operative hysteroscopy, and provide an option to hysterectomy for stopping or reducing menstrual flow.

IHR webites:
Infertility Resources
InfertilityBooks.com
InfertilityProfessionals.com
InfertilityWebsites.com