Uterine Ablation

Uterine Ablation is a procedure that results in a decrease in menstrual flow during the normal menstrual cycle. Approximately 50% of women have complete cessation of menses. The procedure is performed as an outpatient procedure and therefore avoids hospitalization. Because it is an outpatient procedure with no incisions, recovery is much shorter than with a hysterectomy.

Complications with this procedure are rare. The risks associated with any surgery include but are not limited to the risk of an anesthetic, infection, or bleeding. Most patients are healthy and with modern anesthesia equipment and monitoring, complications of anesthesia are rare. The risks of post-operative hemorrhage are less than 5% but may require additional surgery. Infection rates are less than 5%. Since there is a large volume of fluid instilled into the uterus during the procedure, there is the possibility that excess fluid absorption can cause an alteration in blood electrolytes or trouble breathing. If this occurs, it usually corrects itself fairly rapidly. Finally, although rare, there is a risk of puncturing the uterus with the hysterscope. If the uterine perforation is not recognized at the time of surgery and the surgery is continues, injury to the bowels or other intraabdominal organs may cause complications which may require additional surgery.

The HTA System uses a small telescope-like device called a hysteroscope which is inserted into the uterus through the cervix, to help doctors safely confirm proper probe placement and to see the area they are treating. This device circulates heated saline which burns the lining of the uterus. This procedure will stop, or significantly decrease, menstrual bleeding. 68% of patients who have undergone this procedure reported a satisfactory decrease in menstrual flow.  An alternative is the Thermachoice III balloon that is filled with heated fluid to destroy the uterine lining. The fluid is safely contained in a flexible and non-allergenic material that conforms to most uterine shapes and sizes with no reduction of efficacy. 81% of patients report returning to normal levels of menstrual bleeding or lower.

With the Novasure system a mesh is introduced into the cavity and the lining is destroyed by applying electrical energy to the mesh that will thermally damage the adjacent endometrium. 78% of patients have a successful reduction in bleeding down to normal levels.  Older methods utilize hysteroscopy to insert instruments into the uterus to destroy the lining under vision using laser or electrical current in a small loop. Another system introduces a radiofrequency rod that emits energy to destroy the uterine lining.  The procedure is done while the patient is either under local anesthesia, or, if necessary, general or spinal anesthesia. The recovery period can be from one day up to 2 weeks.  After the procedure, the endometrium heals by scarring, reducing or removing the possibility of future uterine bleeding. The patient may develop amenorrhea, however hormonal functioning will remain unaffected. It is still possible to become pregnant after having this procedure. Some type of birth control method must be used after having endometrial ablation.