Chronic abnormal uterine bleeding is a problem that plagues 20% to 35% of women at some time in their lives, and generates 2.7 million office visits each year in the U.S. This chronic heavy or chronic prolonged vaginal bleeding exerts a heavy price in terms of quality of life, lost time from work and healthcare resources. Initial management usually begins with pharmaceutical treatment. While some patients are adequately treated with medical therapy, others may require or desire a longer acting, lower maintenance option. In the past, treatment options were limited and many women required a hysterectomy to control abnormal bleeding. While some cases of abnormal bleeding are still best treated with hysterectomy, newer minimally invasive procedures may offer women relief from chronic benign bleeding without long recovery times or the risks of surgery and general anesthesia.
Endometrial ablation is a minimally invasive option for the treatment of heavy or prolonged vaginal bleeding. The first generation non-resective endometrial ablation device was FDA-approved in 1997. Ablation of the endometrium is performed by inserting a device into the uterine cavity to uniformly destroy the uterine lining. The gynecologist can accomplish this with extremes of temperature—either heating or cooling.
There are currently five non-resective ablation devices available in the U.S. All of these devices reduce bleeding in 80% or more of women who undergo treatment. Once it is confirmed by biopsy that uterine bleeding is not due to endometrial malignancy, the gynecologist may select the most appropriate device for that patient. Uterine size and the size of any sub-mucosal fibroids are factors that affect device selection. The ability to perform endometrial ablation in an office setting offers the benefit of reduced patient costs, greater patient acceptability and ease of scheduling. All non-resective ablation procedures can be performed in the office setting under local anesthesia; however, cryoablation appears to be associated with the least pain during the procedure.
Cryoablation offers two distinct advantages over the heating modalities—decreased operative pain and the fact that it is performed under direct ultrasound guidance. A Heroption device cools the endometrial tissue to sub-zero temperature. This extreme cooling destroys the basal layer of the endometrium and causes numbness. Less operative pain allows us to perform cryoablations in the comfort of an office setting using only oral and local analgesics. In addition, the use of perioperative ultrasound helps to ensure complete ablation and avoid many complications.
Other methods of endometrial ablation use high heat, thus stimulating pain fibers and are therefore usually performed in the operative suite under general anesthesia. In addition, thermal ablations are not routinely performed with ultrasound assistance.
Benefits of Cryoablation
In-office endometrial cryoablation is a safe and effective treatment for benign, heavy or frequent uterine bleeding. Its advantages include avoidance of potential complications associated with general anesthesia or hysterectomy, less pain, and extremely short recovery time.
Recovery Time After Endometrial Ablation
Most patients are able to return to work in one to two days after endometrial ablation. In addition, most studies have shown an 85%-90% satisfaction with treatment after ablation. In one study, 30% of women reported no further periods, 39% reported scanty, infrequent periods, and 29% reported a return to normal light periods at one year follow up.
Dr. Adeboyejo is an OB/GYN with the Holy Cross Medical Group in Fort Lauderdale, FL. For referral information, call 954-900-6653.