Endometrial Ablation

What is endometrial ablation?

 

Endometrial ablation refers to the surgical destruction of the endometrium, the inner lining of a woman’s uterus. Endometrial ablation is not a typical surgical procedure as the doctor never uses a scalpel or makes an incision. Instead, the uterine cavity is accessed through the vaginal canal. It has been performed for nearly 30 years now,¹ and throughout that time, many different techniques have been developed to perform the procedure. Early on, endometrial ablations were performed in an operating room with the patient under general anesthesia, however newer techniques have been developed to allow women’s health specialists to perform these procedures in an office setting with local pain control.²

The new generation of endometrial ablation techniques, referred to as Global Endometrial Ablation (GEA), includes 5 different FDA-approved devices to perform the procedure: thermal balloon, circulating heated saline, bipolar radiofrequency, cryoablation, and microwave energy. No single device and procedure has been shown to be the best, but they all work by destroying the local uterine tissue without causing other damage or systemic effects. In certain situations, hormonal therapy may be initiated for 4-6 weeks to help shrink the fibroids prior to the ablation procedure.³

How does endometrial ablation work to treat fibroids?

Endometrial ablation for fibroids is most beneficial who suffer from excess or abnormal bleeding due to their fibroids, possibly leading to anemia, and it works by destroying the fibroid tissue that causes the abnormal bleeding. The location of the fibroids is very important because endometrial ablation only works on the inner lining of the uterus. This means it is most effective for submucosal fibroids (Types 0, 1, or 2) because they can be accessed by the uterine cavity.⁴ Other fibroids that are more likely to cause symptoms of abdominal pain or pressure or other symptoms may not be as easy to treat with endometrial ablation.

Is endometrial ablation clinically proven?

Many studies have been performed to evaluate the effectiveness of endometrial ablation for fibroids, and their results demonstrate that it is a safe and effective method to treat fibroid-related bleeding.  Overall, the ablation procedure results in a marked decrease in uterine bleeding, and a small minority of women even report a total cessation of bleeding. Because there are so many different methods of endometrial ablation, it can be hard to determine which technique is most applicable. Nonetheless, heating saline ablation and radiofrequency ablation have both been studied recently, and women are typically very satisfied with the procedure and the reduction in uterine bleeding.²⁻⁶

How does endometrial ablation compare to other treatment options?

As compared to other treatment options for fibroids, endometrial ablation does suffer from some limitations. As already noted, the location of the fibroids is an important consideration, and endometrial ablation is also only amenable to fibroids less than 3 cm in size. Additionally, a single endometrial ablation intervention is less likely to be effective than alternative options, in terms of both bleeding reduction and re-intervention rates.⁷⁻⁸ A recent study was performed to compare the re-intervention rates for women after undergoing myomectomy, uterine artery embolization, or endometrial ablation to treat fibroids. A year after the initial procedure, the need for a second procedure was 4.2% for myomectomy, 7.0% for uterine artery embolization, and 12.4% for endometrial ablation. Furthermore, women who undergo endometrial ablation are not recommended to become pregnant, as the procedure leads to increased risk for an abnormal pregnancy.

However, endometrial ablation for fibroids has a couple distinct advantages. It can be done as an in-office procedure, meaning you can often have it performed with your usual doctor. Additionally, it is a very low risk procedure. The most common complications are minor and include bleeding, infection, uterine perforation, and device failure, and the likelihood of having a major complication is well below 1%.⁷

Is endometrial ablation right for me?

Endometrial ablation is not a perfect treatment for fibroids, but it is a good option for women who suffer from abnormal bleeding because of their fibroids. However, like the different types of endometrial ablation, there is no “one size fits all” treatment, so it is important to talk to your doctor and determine which options are appropriate for you and your specific case. If you're considering fibroid treatment, we recommend that you familiarize yourself with all of your options

References

[1] Lomano J. Endometrial ablation for the treatment of menorrhagia: a comparison of patients with normal, enlarged, and fibroid uteri. Lasers Surg Med. 1991;11(1):8-12.
[2] Glasser MH, Heinlein PK, Hung YY. Office endometrial ablation with local anesthesia using the HydroThermAblator system: Comparison of outcomes in patients with submucous myomas with those with normal cavities in 246 cases performed over 5(1/2) years. J Minim Invasive Gynecol. 2009;16(6):700-7.
[3] Stovall DW. Alternatives to hysterectomy: focus on global endometrial ablation, uterine fibroid embolization, and magnetic resonance-guided focused ultrasound. Menopause. 2011;18(4):437-44.
[4] Munro MG. Endometrial ablation: where have we been? Where are we going?. Clin Obstet Gynecol. 2006;49(4):736-66.
[5] Hachmann-nielsen E, Rudnicki M. Clinical outcome after hydrothermal ablation treatment of menorrhagia in patients with and without submucous myomas. J Minim Invasive Gynecol. 2012;19(2):212-6.
[6] Gimpelson RJ. Ten-year literature review of global endometrial ablation with the NovaSure® device. Int J Womens Health. 2014;6:269-80.
[7] Singh SS, Belland L. Contemporary management of uterine fibroids: focus on emerging medical treatments. Curr Med Res Opin. 2015;31(1):1-12.
[8] Davis MR, Soliman AM, Castelli-haley J, Snabes MC, Surrey ES. Reintervention Rates After Myomectomy, Endometrial Ablation, and Uterine Artery Embolization for Patients with Uterine Fibroids. J Womens Health (Larchmt). 2018;27(10):1204-1214.

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The Fibroid Specialists of University Vascular are leading providers of uterine fibroid embolization (UFE), the least invasive treatment option for women suffering from uterine fibroids. Our physicians have devoted their expertise to helping women overcome fibroids without hysterectomy or major surgery. 

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