A New Treatment Option for Heavy
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
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retracted back into the wand, which is withdrawn from the uterus.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
How long is the recuperation
Patients typically feel fine after
about three days and are back to work in less than a week.
Where is the endometrial ablation
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
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.
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