Many women suffer from abnormal uterine bleeding. In the past, this might have been treated with a hysterectomy. Now there are five other options that are approved by FDA. These options affect the uterine lining with the medical term of endometial ablation. Here is what you need to know about these procedures.
Endometial (uterine lining) ablation is a minimally invasive surgical procedure designed to treat abnormal uterine bleeding. It is generally designed to treat intractable cases in which other modalities such as hormonal therapy, D & C, hysteroscopy and removal of pathology have failed to correct the problem. In the majority of cases of abnormal uterine bleeding (AUB) a cause can usually be found and treated (such as hormonal dysfunction, endometrial polyps, uterine myomata, endometrial pathologies and adenomyosis). When those standard diagnostic and therapeutic techniques have failed, in the not to distant past hysterectomy was often the next step. Nowadays, in those select cases endometrial ablation can offer an alternative to hysterectomy. It should not be done unless serious conditions such as uterine cancer have first been ruled out and is not appropriate in those individual who still desire future fertility.
The technique of destroying the endometrium to stop bleeding is not a new one. The technique of using electrosurgery to achieve this aim was originally developed in 1937. Using a probe to destroy the lining by freezing was introduced in 1967. Despite these early techniques, the idea did not become widely used until technological advances allowed visualization of the uterine cavity with hysteroscopy. A hysteroscope is a fiber optic surgical telescope with operating channel passed through a dilated cervix to allow the surgeon to examine and operate within the uterine cavity. The first of these instruments to be used hysteroscopically to destroy the endometrium was the laser introduced in 1981. Subsequently, the urologic resectoscope was utilized to destroy the lining by electrosurgical techniques of resection, vaporization and roller ball electrode. The problem with all of these techniques was that it was technically difficult to destroy every bit of endometrium leading to a higher failure rate than optimal. This led to the development of techniques that destroyed essentially all the endometrium thus called global endometrial ablation (GEA). By destroying essentially all of the endometrium these techniques achieved a high success rate. Advances in computer technology and the ease of instrumentation have increased the availability of these methods. The first of these devices was approved by the FDA in 1997, and others quickly followed.
Currently, there are five FDA approved methods for global endometrial ablation.
(1) Heated Free Fluid (called the HydroThermAblator).
(2) Radiofrequency Electricity (The NovaSure System)
(3) Thermal Balloon (ThermaChoice System)
(4) Microwave energy
(5) Cryotherapy (The Her Option System)
Each of these systems has advantages and disadvantages when compared to each other but all achieve close to the same results. The decision of which system to use depends mostly on the comfort and experience of the surgeon with the device.
Global endometrial ablation for the treatment of intractable uterine bleeding in select individuals offers an alternative to hysterectomy and represents a major advance in the field of gynecology.
Dr. Charles Dubin graduated from UCLA medical school and is a specialist in gynecology, menopause and gynecologic minimally invasive surgery. He is in private practice in Santa Monica, Calif. He was among the first 100 physicians in the United States certified in advanced laparoscopy and hysteroscopy by the Accreditation Council for Gynecologic Endoscopy. He was cofounder of the Westside Menopause Center and a member of the North American Menopause Society. He was founder of the Endometriosis Center of Southern California. Dr. Dubin's practice caters to the needs of perimemopausal and menopausal women employing a customized, holistic approach using hormonal, herbal, dietary and lifestyle approaches.
