Endometrial Ablation vs. Hysterectomy - Which is best for heavy bleeding?
This is a question we are frequently asked. We see many patients who are suffering with heavy bleeding to the point that the bleeding is impacting their lives significantly. There are many advertisements about ablation ("stop the flow') and naturally patients are interested in this possibility.
Endometrial ablation is a 90 second procedure that burns off the uterine lining and causes scarring inside the uterine cavity. In many cases, an ablation stops bleeding altogether. Generally if the bleeding does not stop, it is greatly reduced.
We offer Novasure endometrial ablation in our office. This is a convenient, quick procedure performed under light anesthesia administered by an Anesthesiologist.
For appropriate patients, Novasure ablation is a perfect solution to a very annoying problem. Ablation is not for everyone, however.
Patients who are good candidates for an endometrial ablation are women in their 30's and 40's who have a normal uterus, are bleeding heavily but not experiencing much pain.
Patients with an enlarged uterus due to fibroids or adenomyosis are not good candidates. Endometrial ablations do not tend to be successful on these patients. Patients who experience significant cramping are also not good candidates. Ablation treats heavy bleeding, not pain.
It is important to take into account the fact that sampling the uterine lining after an ablation is no longer a possibility. Ablation causes severe scarring and this prohibits any future endometrial biopsies or D&C's.
Postmenopausal bleeding is a sign of uterine lining cancer (endometrial cancer) and the way we diagnose this type of cancer is through a biopsy or a D&C. If postmenopausal bleeding does occur in a woman who has had an ablation, the only way to detect cancer is to remove the uterus.
For this reason, a significant number of patients who have had a prior ablation end up with hysterectomy.
The other problem with ablation involves trapping of blood inside the uterus. An ablation causes scarring, but does not completely eliminate all of the endometrial cells that produce blood.
Bleeding can occur in the uterine cavity but the blood does not have an exit and therefore collects inside the uterus. This can cause pain.
If your bleeding is heavy, please make an appointment with your practitioner to discuss the options. Your practitioner will schedule an ultrasound to properly diagnose the cause of the bleeding and discuss the findings with you.
For some women, endometrial ablation is a perfect solution to the problem of heavy bleeding. For others, however, removing the uterus laparoscopically is a better permanent solution.