This article looks at the advantages of Endometrial Ablation for the treatment of heavy menstrual bleeding.
Heavy menstrual bleeding is defined clinically as excessive menstrual blood loss which interferes with a woman’s physical, emotional, social and general quality of life.
Treatment as it is now, is limited to either hormonal using norethisterone or myomectomy if fertility is required, or a hysterectomy if fertility is not an issue. Both of these surgical procedures can be associated with major morbidities and rarely mortality.
The major causes of this bleeding are usually uterine fibroids or hormonal bleeding. If fertility isn’t required and the patient has completed her family, then endometrial ablation is a viable alternative when compared to a hysterectomy, especially if fibroids that are present are less than 3cm.
Endometrial ablation is a procedure where the lining of the womb is destroyed via thermal means or via radio-frequency. It has the advantage of being a short procedure which can be done both as an outpatient in an office or as a day-case in hospital. The recovery time is very short which translates to less time off from work, less analgesia and is cost-effective when compared to hysterectomy.
The benefits are even greater if done as an out-patient in an office as there are no associated hospital fees for the theatre, staff and anaesthetist.
Patients can either have complete amenorrhea or vastly reduced menses. The rate of hysterectomy is around ten per cent at five years.
When a patient is counselled for this procedure, there are a few criteria which must be met.
The first is they must have completed their family. The reason [being that] the egg would not implant if pregnancy would to occur after the procedure, because the lining is destroyed. This would result in a miscarriage. Hence, the patient is counselled about long term contraception.
The second is that the endometrial lining must be normal. An endometrial biopsy is done prior to the procedure to make sure there are no abnormalities.
For best results, the endometrial cavity must be less than ten cm; if it isn’t, another procedure called TCRE will be the treatment of choice.
The thickness of the uterus is sometimes measured, especially if [there has been] a caesarean section, to ensure that the thickness is at a required level for the procedure [to be performed].
As with any procedure, one [must] discuss risks. The most frequent may be infection, but the rate of this is very low. There is a risk of perforation of the uterus. This [risk is higher] if one has to dilate the cervix at the beginning of the procedure. If dilation is done, then the surgeon will do a diagnostic hysteroscopy before and after the surgery to make sure the uterus is intact. In addition, the machine that is used can detect any abnormality and will terminate the procedure automatically.
In conclusion, endometrial ablation is a viable alternative. It gives our women further choices in the management of their condition and is cost effective; there is a decreased complication rate, a quicker recovery time and most importantly, their uterus is conserved.
(Dr John Barker Bsc MBBS DFSRH MRCOG BSCCP(cert), Dip(Risk Management). Consultant Obstetrician/Gynaecologist at JRB Medical Centre, 7th Avenue Belleville.
His special interests include Gynaecological Oncology, Emergency Gynaecology, Alternatives to hysterectomy, out-patient hysteroscopy, high-risk obstetrics.)