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more articles by Gardner, Kathleen , MD  |  author's bio

A New Treatment Option for Heavy Menstrual Bleeding

A New Treatment Option for Heavy Menstrual Bleeding

By Kathleen Gardner, MD

 

Heavy menstrual bleeding (menorrhagia) is an unpleasant, embarrassing fact of life for about one in five women. This condition affects how women feel, the clothing they wear, and where and when they take vacations. It leaves women anemic, tired, and anxious and can have a detrimental impact on both their familial and work relationships.

 

There is now a new approach to treating menorrhagia for women who are past their childbearing years. The treatment, which is a form of endometrial ablation, is safe and stops or significantly decreases menstrual blood flow in most women.

 

What is endometrial ablation?

 

Endometrial ablation is a way to specifically destroy the lining of the uterus, which is the source of the menstrual flow. This new approach, marketed under the name NovaSure, uses electrical energy to cauterize (or heat) the lining of the uterus, which is then sloughed off by the body.

 

How is this different from other approaches to treatment?

 

Historically, menorrhagia has been surgically treated by hysterectomy, in which the entire uterus is removed, or dilation and curettage (D and C), which essentially scrapes the uterine walls. More recently, various forms of endometrial ablation have become available. One method utilizes a tiny roller ball to cauterize the lining of the uterus but this is a rather tricky, tedious procedure that has the associated risk of burning too deep into the tissue. Another ablation process involves the deployment of a small balloon into the uterus, which is then filled with hot dextrose that presses against the lining and destroys it.

 

How does this new form of ablation work?

 

The surgeon begins by measuring the depth of the uterine cavity. A slender, hollow wand containing a triangular piece of gold mesh is inserted through the cervix and the mesh is deployed inside the uterus. This mesh heats the endometrium in a very controlled fashion, using electric cautery. The heat and timing, which are calculated for the width and depth of the individual uterus, shut off automatically following a consistent application throughout the entire uterine cavity. The mesh is then retracted back into the wand, which is withdrawn from the uterus.

 

Are there any risks?

 

Yes, there are always risks associated with any ablative technique. There is surface scarring on the walls of the uterus, which can create adhesion. And any uterine surgery runs the risk of perforation.

 

How long is the recuperation period?

 

Patients typically feel fine after about three days and are back to work in less than a week.

 

Where is the endometrial ablation performed?

 

This is outpatient surgery that is performed at Cayuga Medical Center and Surgicare. Patients are typically awake for the procedure, which is performed with spinal anesthesia. Some patients choose to watch the procedure on a video monitor in the operating room as it is being performed.

 

Are there women with heavy menstrual bleeding who are not candidates for this procedure?

 

Prior to endometrial ablation, your surgeon will do a preoperative uterine biopsy to ensure that endometrial ablation is the appropriate course of treatment for you. There are contraindications for endometrial ablation. Women with fibroid tumors in the lining of the uterus cannot undergo ablation until the fibroids (benign tumors) are treated. This procedure is also not for women with uterine cancer.

 

If you are woman who is suffering heavy regular or irregular bleeding, and you are past your childbearing years, consider talking with your gynecologist about this approach to treatment. It is a safe, effective procedure from which most women recover quite rapidly, and it could help solve a troubling, inconvenient problem.

 

Dr. Gardner is board certified in obstetrics and gynecology, and is a Fellow of the American College of Obstetrics and Gynecology. She serves on the medical staff of Cayuga Medical Center and is in practice with Ob-Gyn Associates of Ithaca, where she can be reached at (607) 266-7800. Dr. Gardner, who graduated with high honors from medical school at the University of Pittsburgh, is accepting new patients.

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