Endometrial Ablation - The Second Generation
By Hope Waltman
Excessive menstrual bleeding (menorrhagia) is a medical
condition that causes women to be prisoners in their homes for several days a
month and it can even cause women to have to go to the hospital for emergency
Paul Indman, M.D., is recognized worldwide for his
expertise in the treatment of excessive menstrual bleeding and the training of
physicians on this medical condition. He
has a private medical practice in San Jose, California.
I interviewed Dr. Indman and asked him several questions about excessive
menstrual bleeding and the Endometrial Ablation procedure.
questions and examinations should be performed to evaluate abnormal uterine
At the initial office consultation I ask my patient
about the amount and regularity of bleeding and how it impacts her life.
I try to determine if she is ovulating, or using medication that may
increase her bleeding. It is important to evaluate her uterus. Since many problems, such as polyps or fibroids inside of the
uterus may not be detected by pelvic exam, I always do an ultrasound at the
first visit. This only takes a few
minutes, and frequently finds the cause of the bleeding.
Many times I will confirm the diagnosis at another visit by looking
inside the uterus with a slender telescope called a hysteroscope.
This can easily be done in the office setting.
What is Endometrial Ablation?
Endometrial Ablation is a treatment for heavy bleeding that
removes or destroys the endometrium (lining of the uterus).
It is an outpatient procedure, and most women can return to normal
activities within a day or two. There
are a number of methods by which this can be done.
For years I have used a slender telescope called a resectoscope.
This allows me to see inside the uterus and treat the lining so it will
no longer bleed. In addition, I can
use the same instrument to remove polyps and fibroids that are inside the cavity
of the uterus. There are also a
number of new devices, such as the Novasure, that allow me to quickly treat the
entire lining at once. Many
women who otherwise would have had a hysterectomy or who live with heavy
bleeding will be able to avoid major surgery by having an endometrial ablation.
Is there a
medical standard of training required for all physicians who perform Endometrial
Unfortunately there is no
standard physician training requirement for the Endometrial Ablation procedure.
Expertise in doing the procedure varies widely from physician to
What makes Endometrial Ablation
better than a D&C?
A D&C (dilation and curettage) is a blind procedure
that scrapes some the surface of the lining of the endometrium.
While it can be effective in stopping acute bleeding, it rarely has any
lasting effect. In fact, there is
not a single study published in the medical literature showing any long-term
benefits. You can think of a
D&C as similar to mowing a lawn ó it will grow back as long as you leave
the roots. Endometrial ablation
treats deeper to prevent regrowth of the lining.
What is the
latest generation of Endometrial Ablation technique and how does it vary with
the first generation ablation?
The first successful endometrial ablation used a Nd:YAG
laser. Most of us switched to using
a resectoscope, as it is faster and safer.
Both of these methods require extensive training and skill to perform
safely and effectively. Because of
this, we worked on developing simpler methods that treat the entire uterine
lining at one time.
The first of these methods, the Thermachoice, used a
balloon placed inside the uterus and circulated hot water in the balloon.
Although most women had a decrease in bleeding, only 13% of women stopped
bleeding entirely. The HTA
Hydrothermablator circulates hot water under direct vision through a
hysteroscope. Fewer women continue
to bleed after this method.
The Novasure procedure is another new endometrial ablation
technique. It is done in an
outpatient setting under local anesthesia with sedation, or general anesthesia.
A sheath containing an electrode, is
inserted through the cervix. The
sheath is pulled back to expose an electrode, which expands to conform to the
uterine cavity. The electrode is
activated and will automatically turn off when the treatment is complete.
The uterus is treated for approximately 90 seconds.
Most women can go home within an hour after the Novasure procedure.
What are the advantages of
The Novasure system is the most rapid of all the
endometrial ablation techniques. The
success rate is high and it has a low complication rate.
No hormonal pretreatment is required and the procedure can be done at any
time of the menstrual cycle.
What are the disadvantages of
Since endometrial ablation destroys the lining of the
uterus, only women who have completed childbearing should consider the
procedure. For most women the
effects are permanent, but some women may have recurrence of heavy bleeding or
cramping. Fortunately, it is
usually possible to determine if a woman is at high risk for failure of the
procedure, so she can be counseled appropriately.
Like any surgical procedure, there can be complications, but the risks
are low when it is performed by an experienced gynecologist.
that you may want to ask the doctor are: What
training has he or she had in Endometrial Ablation techniques?
What is his or her success rates with ablation?
Does he or she just do one method or is he or she familiar with a number
The Novasure Endometrial Ablation procedure is
definitely worth researching before making a decision about treating excessive
For more information on heavy bleeding and Endometrial
Ablation refer to Dr. Paul Indmanís new web site, www.heavybleeding.com
or you can contact him at 15195 National Avenue, Suite 201, Los Gatos,
California 95032, (phone)
Refer to http://www.hopeforfibroids.org/faq2pg2-videoresearchandtreatments.html
for more information on other treatments that are available.