Endometrial ablation
Encyclopedia
Endometrial ablation is a medical procedure
that is used to remove (ablate
) or destroy the endometrial lining of a uterus
. This technique is most often employed for people who suffer from excessive or prolonged bleeding during their menstrual cycle
but cannot or do not wish to undergo a hysterectomy
. The procedure is most commonly done on an outpatient basis. Placenta accreta
may occur if the patient becomes pregnant after endometrial ablation, so birth control
is recommended.
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. 94% 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. 68% 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. 87% 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 radio-frequency 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.
Medical procedure
A medical procedure is a course of action intended to achieve a result in the care of persons with health problems.A medical procedure with the intention of determining, measuring or diagnosing a patient condition or parameter is also called a medical test...
that is used to remove (ablate
Ablation
Ablation is removal of material from the surface of an object by vaporization, chipping, or other erosive processes. This occurs in spaceflight during ascent and atmospheric reentry, glaciology, medicine, and passive fire protection.-Spaceflight:...
) or destroy the endometrial lining of a uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
. This technique is most often employed for people who suffer from excessive or prolonged bleeding during their menstrual cycle
Menstrual cycle
The menstrual cycle is the scientific term for the physiological changes that can occur in fertile women for the purpose of sexual reproduction. This article focuses on the human menstrual cycle....
but cannot or do not wish to undergo a hysterectomy
Hysterectomy
A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...
. The procedure is most commonly done on an outpatient basis. Placenta accreta
Placenta accreta
Placenta accreta is a severe obstetric complication involving an abnormally deep attachment of the placenta, through the endometrium and into the myometrium...
may occur if the patient becomes pregnant after endometrial ablation, so birth control
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
is recommended.
Procedure
A number of competing procedures are available.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. 94% 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. 68% 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. 87% of patients have a successful reduction in bleeding down to normal levels.
Older methods utilize hysteroscopy
Hysteroscopy
Hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention .-Method:...
to insert instruments into the uterus to destroy the lining under vision using laser
Laser
A laser is a device that emits light through a process of optical amplification based on the stimulated emission of photons. The term "laser" originated as an acronym for Light Amplification by Stimulated Emission of Radiation...
or electrical current in a small loop.
Another system introduces a radio-frequency 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
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
. 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.
Effectiveness
Approximately 90% of those who undergo this procedure will have reduced menstrual bleeding. Of those, approximately 45% will stop having periods altogether. However, a second procedure or a hysterectomy will be required in approximately 22% of cases.Risks
Although uncommon, the procedure can have serious complications including:- Perforation of the uterus
- Burns to the uterus (beyond the endometrial lining)
- Pulmonary edemaEdemaEdema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
or embolismEmbolismIn medicine, an embolism is the event of lodging of an embolus into a narrow capillary vessel of an arterial bed which causes a blockage in a distant part of the body.Embolization is... - Bowel Burn
- Post-ablation tubal sterilization syndrome