Greg Heal, MD

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Hysteroscopic Endometrial Ablation

An Endometrial Ablation is the 21st century evolution of the D&C (Dilation and Curettage)  D&C is one of the most common surgical procedures performed.  It is usually done to stop abnormal heavy uterine bleeding in women in their 40's.  The "D" in D&C  stands for the dilation of the cervix, usually 8 to 10 mm.  This then allows the "C" in D&C, which stands for curettage, the removal of the bleeding tissue in the uterine cavity.  Patients often refer to a D&C as a Dusting and Cleaning.  As a surgical procedure a D&C has a lot of benefits and few risks.  The main problem with a D&C is that is was usually a temporary fix.  The woman's periods would return to normal for a time, but the tissue in the uterus would begin to build up again and her heavy menstrual flows would return and she would either have to have another D&C or a hysterectomy.

The benefit of an Endometrial Ablation is that it prevents the tissue from building up again in the uterus.  An Endometrial Ablation is designed to give permanency to a D&C and actually improve upon it by eliminating the menstrual flow.  This is achieved by eliminating the endometrium, which is the lining of the uterine cavity that regenerates every month.  With this layer gone, menstruation stops.

There are two types of Endometrial Ablation.  The original gold standard ablation is performed using a Hysteroscope.  This is a camera that is placed through the cervix to allow visualization of the uterine cavity while the procedure is performed.  In the past few years there have been multiple non-hysteroscopic ablation procedures developed.  These procedures employ devices that are placed in the uterus to destroy the endometrial lining.  These procedures are done "blind", not under visualization.  This does not allow a custom ablation of the entire uterine cavity, since no two uterii are the same size or shape.  Since the entire uterine cavity is not ablated the uterus will continue to menstruate, just not as much.  The only advantage of non-hysteroscopic ablations is that they were designed to be done in a doctor's office with the patient awake.  This is rarely done in an office setting since doing an ablation this way can be very uncomfortable for the patient.

Dr Heal performs a Hysteroscopic Endometrial Ablation in either a hospital or surgical center with the patient asleep under anesthesia.  In this procedure an electrical current is passed through a small metal roller that removes the lining of the uterus and seals the underlying blood vessels to a depth of 3 mm.  This hysteroscopic method is designed to eliminate menstruation, which it does in about 80% of patients.  The remaining 20% have very light menses.

The advantages of a Hysteroscopic Endometrial Ablation are:

  • It is done under visualization which allows removal of any small polyps or fibroids that may be present
  • It allows the entire uterine cavity to be ablated regardless of the size and shape of the uterus
  • If the patient had a previous cesarean, that area can be avoided if it is thin to avoid complications
  • There is no cutting or stitching involved, the patient can resume normal activities the following day
  • It is designed to stop uterine bleeding, not just improve it as the non-hysteroscopic methods do
  • Outpatient procedure with return to normal activities the next day

The Disadvantages and Risks of any ablation procedure are:

  • Anesthesia risks, primarily aspiration complications (this is why you don't eat or drink for 8 hours before surgery)
  • Perforation of the Uterus, especially with history of prior cesarean, which is why visualization is so important
  • Infection (a risk with any surgery but so low with this procedure that routine pre-operative antibiotics are not given)
  • Will not treat any fibroids in the underlying myometrial layer of the uterus that may continue to grow and cause bleeding in the future.

Childbearing should be completed before considering this procedure.  It has never been studied as a form of birth control, so some type of birth control should be used after an ablation procedure.

 To find out if this quality of life enhancing procedure is right for you, call to schedule an appointment with Dr Heal.



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