Hysterectomy & alternatives
Endometrial ablation — pros and cons
Endometrial ablation can be a useful
alternative to hysterectomy when other less invasive measures fail or, for
example, if a woman does not wish to try
medical (hormonal) management, and she is intent on keeping her uterus.
The word ablation means “to remove by erosion, melting, evaporation,
or vaporization.” Endometrial ablation is performed with a hysteroscope, together
with a device which heats up, freezes or lasers the
endometrial lining. By destroying a layer of the endometrial lining, periods
in the majority of cases stop altogether — at least for a while — and
most women cannot get pregnant after uterine ablation therapy. However, on rare
occasions women do get pregnant after this procedure, so it’s important that
birth control or sterilization be discussed, as post-ablation pregnancies are risky
(some insurers actually require sterilization before they’ll pay for ablation).
This procedure can be done by a trained GYN in the office relatively quickly and
easily. It can also be useful for selectively treating areas of the endometrial
lining; for example, it can be performed under anesthesia following
hysteroscopically–guided D&C sampling, which may be ideal to rule out pathology
rather than assuming an
endometrial biopsy is adequate.
At Women to Women we do not often send women for this procedure for several reasons.
For one, we always try to go for the minimally invasive procedures and medically
manage when possible, and we generally get good results with
medical management of our patients with
heavy bleeding. Although endometrial ablation does work very well for
some women, long-term results for treating heavy bleeding with endometrial ablation
are not always satisfactory, with a relatively high rate of reoccurrence. Our Nurse–Educators
have heard back from women in the Personal Program who have had ablation that it
has failed and their heavy periods returned in a year or two. There is also some
element of risk that endometrial ablation could have the effect of masking endometrial
cancer later in life, because it removes the opportunity for endometrial spotting
to signal that something abnormal is going on.
To sum up, endometrial ablation has its limitations. With time we can look forward
to medical technology bringing us more advanced treatment
alternatives to hysterectomy. But in the interim, ablation techniques do
offer women and their gynecologists options that can be very useful in certain circumstances.
Last Modified Date: 04/20/2011
Principal Authors: Dixie Mills, MD
& Marcy Holmes, Certified Menopause Clinician