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Dr Marlena du Toit

Endometrial ablation PDF Print E-mail

Hysteroscopy and endometrial biopsy is now the first-line investigation of women with abnormal uterine bleeding since it allows direct visualization of the endometrial cavity and the opportunity to obtain a directed endometrial biopsy.

If medical and hormonal treatment fails as management options for menorrhagia, surgical options should be explored.

When surgery is considered for management of menorrhagia, endometrial ablation can be considered in the first place. Endometrial ablation is the elimination of the endometrium by thermal energy or resection. The aim is to destroy the full thickness of the endometrium and also the endometrial glands in the superficial myometrium. With endometrial ablation the uterus is preserved and this is less costly and less invasive than hysterectomy. It is designed to treat AUB in women with no intrauterine pathology. It is therefore good practice to perform a hysteroscopy prior to this procedure.

A woman who has had ablation still has all her reproductive organs. Routine Pap tests and pelvic exams are still needed.

Endometrial Ablation Methods

Endometrial ablation is a short procedure. The procedure done as day patient surgery, meaning that you can go home the same day. Your will receive a general anaesthetic. Your cervix may be dilated before the procedure. Dilation is done with medication or a series of rods that gradually increase in size, whilst under anaesthetics.

There are no incisions (cuts) involved in endometrial ablation. Recovery takes about 2 hours, depending on the type of pain relief used. The type of pain relief used depends on the type of ablation procedure, where it is done, and your wishes. Discuss your options with your doctor before you have the procedure.

The following methods are those most commonly used to perform endometrial ablation:

Preferred method in my practice

  • Heated balloon — a balloon is placed in the uterus with a hysteroscope. Heated fluid is put into the balloon. The balloon expands until its edges touch the uterine lining. The heat destroys the endometrium

Other methods:

  • Radiofrequency —a probe is inserted into the uterus through the cervix. The tip of the probe expands into a mesh-like device that sends radiofrequency energy into the lining. The energy and heat destroy the endometrial tissue, while suction is applied to remove it.
  • Freezing — a thin probe is inserted into the uterus. The tip of the probe freezes the uterine lining. Ultrasound is used to help guide the doctor during the procedure.
  • Heated fluid—Fluid is inserted into the uterus through a hysteroscope. The fluid is heated and stays in the uterus for about 10 minutes. The heat destroys the lining.
  • Microwave energy—A special probe is inserted into the uterus through the cervix. The probe applies microwave energy to the uterine lining, which destroys it.
  • Electrosurgery — Electrosurgery is done with a resectoscope. A resectoscope is a slender telescopic device that is inserted into the uterus. It has an electrical wire loop, roller-ball, or spiked-ball tip that destroys the uterine lining. This method usually is done in an operating room with general anesthesia. It is not as frequently used as the other methods.

Indications for Endometrial Ablation

  • Disabling intrauterine bleeding for disruption of lifestyle, convenience, or
  • unexplained bleeding on hormone replacement therapy (ACOG Technical Bulletin, February 1990)
  • Failed traditional therapies
  • Contraindications to medical treatment
  • Poor surgical risks for hysterectomy
  • To preserve the uterus

Contra-indications for Endometrial Ablation

Relative:

 

  • Endometrial hyperplasia
  • Dysmenorrhoea
  • Chronic pelvic pain
  • Premenstrual syndrome
  • Multiple or large uterine fibroids
  • Enlarged uterus(more than 12cm cavity length)
  • Uterine prolapse

 

Absolute

 

  • Genital tract malignancy
  • Women wishing to preserve fertility
  • Intrauterine pregnancy
  • Women expecting amenorrhoea as an outcome
  • Acute pelvic inflammatory disease
  • Previous classical caesarean section

Pregnancy following Endometrial Ablation

The reported rate for pregnancy post EA is 0, 65%. It is generally assumed that pregnancy is unlikely following EA. Potential complications of pregnancy following EA must be anticipated. The patient must be counselled regarding the increased risk of miscarriage, antepartum haemorrhage, intrauterine growth restriction, preterm delivery, perinatal mortality and abnormal placentation necessitating hysterectomy. It is vital that an informed decision is made.

What to expect after the procedure

After the procedure you may experience some minor side effects:

 

  • Cramping, like menstrual cramps, for 1–2 days
  • Thin, watery discharge mixed with blood, which can last a few weeks. The discharge may be heavy for 2-3 days after the procedure.
  • Frequent urination for 24 hours
  • Nausea

 

Just keep in mind that with this procedure a burn wound will be created and the healing there of will take time. Vitamin supplementation will enhance the healing process.

It will also be helpful to keep a menstrual calendar of the bleeding pattern until amenorrhea are achieved.