Monday, August 26, 2013

Ask Us Anything: My Doctor Recommended Ablation for My Heavy Periods. Can You Tell Me More?

"I have had heavy periods that last for a month or more. I am in my late 40's. My doctor talked about an ablation. Can you tell me more? I am worried about missing a lot of time from work."

Dr. Diane Sutter Responds: 

A small device is place into the uterine cavity and the superficial endometrium is temporarily destroyed. The procedure is very quick, usually under 10 minutes and can result in very light or absent menses for as long as 5 years.

Uterine ablation can take place in your gynecologist's office or as an outpatient surgery, and you may not need to take off more than one day from work.

Dr. Ali Ghomi Adds:

Endometrial ablation is considered the least invasive surgical option to address menorrhagia or heavy periods.

 The procedure is considered highly effective with an overall patient satisfaction rate of 80%. Approximately one-third of women stop having periods altogether after ablation. 

Complications of surgery are extremely rare. A small percentage of women experience worsening of uterine cramping after ablation, especially if they have had history of cesarean sections, tubal ligations or fibroid uterus.

This is an outpatient procedure. Recovery is usually a matter of days. Some women experience significant uterine cramping up to 72 hours after surgery.

Overall, patients do very well after endometrial ablation. There are different modalities of performing endometrial ablation, but no one technique has been found to be superior to the other.

Dr. Scott Zuccala Adds:

I think it important to have a proper work up for abnormal bleeding, one of the most common causes for visits to the gynecologist.

The work up may include a pelvic sonogram, pap test, endometrial biopsy, cbc and pelvic exam. The cause of the bleeding will dictate the treatment, as well as a person's expectations.

If there is no problem with the endometrial lining, such as hyperplasia (abnormal growth) and no fibroids that extend into the cavity, then an ablation is a reasonable option. Although it should be remembered that it is not a form a birth control.

Medical therapy should also be reviewed, as should birth control pills, progesterone, progesterone IUD and lysteda. These forms work in many circumstances and do not expose the patient to surgery.

That being said, an ablation is an excellent alternative that allows conservative treatment and short recovery with people returning to work/activities within 2 to 3 days. The downside is that it does not always fix the problem. Conditions such as adenmyosis (deeply embedded endometrial tissue) may affect the results.

The key is to have a diagnosis before treatment, if possible, so that the treatment can be tailored to the cause. And just as important is to have a realistic expectation of the result.

About Our Physicians

Dr. Diane Sutter

Dr. Sutter is a gynecologist whose interests include menopausal transition, osteoporosis diagnosis and treatment, and PMS. She sees patients at her office in Kenmore, NY.

Dr. Ghomi

Dr. Ghomi is the Director of Minimally Invasive Gynecologic Surgery and Chair of The Robotic Surgical Committee at Sisters of Charity Hospital.

Dr. Zuccala

Dr. Zuccala is a gynecologic surgeon at Mercy Hospital of Buffalo.

He practices obstetrics and gynecology, including minimally invasive surgery, and vaginal and pelvic reconstruction for prolapse and urologic incontinence surgery.

He was one of the first surgeons in the Buffalo area to perform minimally invasive gynecological surgery for non-cancerous conditions using the da Vinci® Robotic Surgical System.

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