The endometrium is the inner lining of the uterus. It undergoes cyclical changes during the menstrual cycle beginning with growth, development of the glands and blood vessels and ends in degeneration and shedding. These changes are based on the hormonal changes in the menstrual cycle. During the phase of shedding, in some instances, the bleeding can be very heavy and last quite long. For such patients Endometrial Ablation is a good option. It treats the lining of the uterus. Ablation means destruction. Thus the endometrium is destroyed in order to stop the bleeding. It does not involve removal of the uterus neither does it affect the woman’s hormone levels.
In cases where there is heavy menstrual bleeding, the first line treatment includes medication. In case medication fails, ablation can be used to treat the bleeding. After ablation in most cases, the bleeding stops or is brought down to negligible levels. However if bleeding continues, surgery is the next option.
Once ablation is carried out, the woman is unlikely to become pregnant. Thus, the patient must be made well aware that her child bearing capacity after this procedure comes to a halt. The target population for Endometrial Ablation must be women who have completed their family or those who are not desirous of conceiving. Even if pregnancy occurs, the rates of miscarriage are quite high. Thus women who have undergone this procedure should use birth control measures until menopause or may undergo any sterilization procedure.
Women who have undergone ablation retain their reproductive organs as against women who have undergone hysterectomy with or without bilateral oophorectomy.
Contradictions: Post menopause, cancer of the uterus, endometrial hyperplasia, recent pregnancy, current or recent infection of the uterus, disorders of the uterus and the endometrium.
Selection criteria: All of the following selection criteria must be fulfilled:
- · Menorrhagia: Which has not responded to: Dilatation and Curettage or to medical or hormonal therapy.
- · Gynaecological examination and Pap smear has proved negative for any major abnormality.
- · Endometrial sampling has been done and it has excluded presence of any cancerous condition or precancerous condition as well as any fibroid, polyp or any structural abnormality of the uterus.
Methods: The following methods are most commonly used to perform Endometrial Ablation:
Electro surgery- a resectoscope is inserted and the tip of it destroys the endometrial lining of the uterus,
Microwave energy – a probe is inserted into the uterus and microwave energy is used to destroy the endometrium,
Heated fluid- hot fluid is used to burn the endometrium,
Freezing- a probe is inserted into the uterus and the tip of probe destroys the endometrium by freezing,
Radiofrequency- the tip of the probe emits radiofrequency waves to destroy the uterine lining,
Heated balloon- the balloon is filled with hot fluid once inflated the hot fluid touches the wall of the uterus and burns the endometrium.
The procedure may be done under local anaesthesia or spinal anaesthesia or general anaesthesia.
Risks: Endometrial Ablation has certain risks such as infection, bleeding and perforation of the uterine wall or bowel.
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