By: Bradley G. Goldberg, M.D.

Hysterectomy is one of the most common surgical procedures performed in the United States, with approximately 600,000 of these surgeries being performed each year. Although there are many reasons for a woman to need a hysterectomy, problems with abnormal or heavy bleeding account for up to 30 % of all hysterectomies.

If you are one of these women, there is good news! Medical technology in the form of a procedure called “Endometrial Ablation” can now save many of you from undergoing a hysterectomy. Although this technology has been around for several years, the risks of patients absorbing dangerously high volumes of fluid during this procedure had created a reluctance to use the technology.

As with any procedure, there are still risks but the recent development and refinement of fluid monitoring systems have now made this procedure very safe.

While not all patients qualify for this procedure, many will. The ideal candidate is a woman who suffers from excessively heavy or frequent periods which have not responded to hormonal medications. This bleeding should not be due to large fibroid tumors, and the possibility of cancer should be eliminated. In addition, women who are interested in having more children are not considered candidates for this procedure.

The endometrial ablation is performed as an outpatient procedure under general anesthesia. No incisions are needed and the patient leaves the hospital a few hours after treatment. The procedure is performed with an instrument called the “resectoscope” which is directly inserted into a woman’s uterus through the natural opening in the cervix. The resectoscope has an electrode that the surgeon uses to drag along the lining of the uterus to destroy the cells that produce a period each month. After treatment, most patients are not in pain and only experience cramping which usually responds to Tylenol or Advil.

Several years of follow up studies have proven that the results from endometrial ablation are very good. Almost 85-90% of women having this procedure are pleased with their results. Of these women, approximately half will not have any further periods. The other half have much lighter periods to the extent that they are glad they had the procedure performed.

Exciting new results are also being obtained with a device referred to as the “thermal uterine balloon”. This device consists of a balloon inserted into the uterus and then filled with fluid at near 400 degrees. The idea is to obtain destruction of the uterine lining similar to that obtained with traditional endometrial ablation. The wonderful part about this treatment is that it can be performed in the doctor’s office with limited anesthesia. Data is not as extensive on this system yet, but it does seem very promising.

Overall, the Endometrial Ablation procedure in conjunction with the new fluid monitoring systems provides women with a safe, less painful, and less expensive alternative to hysterectomy for the problem of abnormal uterine bleeding.

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