Uterine fibroids affect between 30% and 75% of women who are between the ages of 30 and 50. The difference in statistics is the result of the severity of symptoms which may or may not bring a woman to her gynecologist for treatment. Symptoms which are common in women who have uterine fibroids include feelings of heaviness in the pelvic region, heavy menstrual bleeding, urinary tract symptoms and pain and discomfort. One option for treatment is an endometrial ablation. (1)
In a study published in July 2006 in the Journal of Reproductive Medicine researchers published their findings and discovered that endometrial ablation is more cost-effective for the treatment of heavy menstrual bleeding than is oral contraceptives or hysterectomy. (2)
The procedure, endometrial ablation, was first described in the literature in 1980 and used a hysterocopic view to perform the procedure. Using this procedure, a surgical device is inserted through the vagina, the cervix and into the uterus. The procedure removes the lining of the uterus to help decrease menstrual flow or stop it completely. This lining is normally lost on a monthly basis during the menstrual period. The procedure does not require hospitalization and most women can return to normal activities within a day or two. The procedure is an alternative to hysterectomy.
Following the initial development of the procedure, second generation techniques are being developed to overcome the shortcomings that surgeons find with a hysterocopic view while continuing to keep the recovery time short. One such technique is currently approved by the US FDA is a hot water balloon. Other techniques are in testing and in process of becoming approved. These techniques are more advanced and less invasive and they also carry less risk and women are finding that outcomes are better.
One technique is the microwave endometrial ablation technique. Early case studies use general anesthesia but it is currently being done under local anesthetic in the office. Those procedures done in the office have a greater risk because the uterus is not visualized during the procedure. A comparison study of a microwave endometrial ablation procedure with other standard procedures using balloon technology showed that 94% of the patients were satisfied with the MEA. Using an MEA there is a 10% repeat surgical procedure rate 12 months following the initial one. More studies are needed in order to determine if the procedure has acceptable risk done in the gynecologist office. (3)
Physicians choose to begin treatment for heavy menstrual bleeding using the least invasive options available, which are oral contraceptives. In one study researchers found that contraceptives reduced menstrual bleeding by only 47%. Unfortunately once women stopped using oral contraceptives, heavy bleeding returned. Women who undergo endometrial ablation may use oral contraceptives for three months in order to help reduce menstrual bleeding flow prior to the procedure. (4)
Long-term follow-up studies of women who have undergone endometrial ablation find that five years after treatment 95% of the women still report normal bleeding or less. It has a high rate of success for treatment of heavy periods but can effectively eliminate the chances of having any children. For this reason the procedure is not recommended for women who have not yet completed their families. (5)
Risks from the procedure also can include blood loss, heat burns to the internal organs, electrical burns, perforation of the uterus (all whole in the uterine wall) or leakage of the heat fluid from the balloon. The risks are very real as the surgeon requires enough heat to remove a full thickness of the uterine lining with the superficial myometrium. To decrease the risk of bleeding in perforation it is necessary to destroy tissue up to 5 mm deep.
This procedure is a significant advancement in the treatment of heavy menstrual flow for women who want to keep their uterus and are sure that they have finished their families. Recovery time is significantly less than it is for hysterectomies and it does not carry with it side effect of early menopause. Whether ovaries are removed during a hysterectomy or not, the surgical procedure of the hysterectomy will cause a woman to experience menopause earlier than she would have normally.
Uterine endometrial ablation carries with it much less risk, a shorter recovery time and the ability to go through menopause when her body was already pre-programmed to achieve this milestone.
(1) national uterine fibroid foundation: Statistics
(2) American Family Physician: Treatment of Menorrhagia
(3) US Department of Health and Human Services: Microwave Endometrial Ablation
(4) Cochrane Database Systematic Reviews: Oral contraceptive pills for heavy menstrual bleeding
(5) Human Reproduction:Uterine endometrial thermal balloon therapy for the treatment of menorrhagia: long-term multicentre follow-up study
RESOURCES
Archives of Gynecology and Obstetrics: Microwave Endometrial ablation as an Alternative to Hysterectomy
American Family Physician: Treatment of Menorrhagia