2091 Endometrial Ablation

Apr. 7, 2004

 

 

Endometrial Ablation

A common problem
Every year about 650,000 American women have hysterectomies. This
operation involves surgical removal of the uterus. Many of the women
who have this operation do so because of heavy or prolonged periods.

An alternative
Endometrial ablation offers an effective alternative to hysterectomy
for patients suffering from heavy or prolonged bleeding during their
period. It is often chosen when other medical treatments have failed
or are otherwise undesirable. This procedure involves the removal of
the lining of the uterus, which is the source of the bleeding.

According to recent studies, most women feel that endometrial
ablation relieves the problem with their period. Up to 90% of women
who have this procedure are satisfied with the results. After the
procedure, the women who were satisfied with it reported lighter
periods or normal periods. Some women said that their periods stopped
completely after endometrial ablation.

Tests
Your physician will take your medical history and perform a physical
exam to see if endometrial ablation is right for you.

Other tests could include some blood tests, uterine lining sampling
(biopsy), and hysteroscopy and/or ultrasonography. These procedures
are usually done in your physician's office and are quick and
relatively painless.

Drugs
For 1 to 2 months before the procedure you may have to take
medication, possibly injections, to decrease the thickness of the
endometrium (uterine lining). A GnRH analog may be used for this
purpose. Thinning the uterine lining exposes the lower (basal) layer
of endometrial cells; this is the tissue your physician will remove
with electrosurgery. The day prior to surgery, your physician may
choose to place a laminaria to gradually dilate your cervix the night
before your surgery.

What to expect
Endometrial ablation is an outpatient surgical procedure; this means
that you will enter the hospital, have surgery, and usually go home
the same day.

The entire procedure usually takes only 15 to 45 minutes. You will
then be taken to the recovery room for rest and observation, and will
be allowed to go home when you have fully recovered from the
anesthesia. It usually takes an hour or two to recover from
anesthesia.

The procedure
Endometrial ablation is performed during a procedure called operative
hysteroscopy. A narrow viewing tube is inserted through the vagina
and the cervix into the uterus. A tiny camera attached to the viewing
tube (hysteroscope) allows the uterine cavity to be shown on a TV
monitor during surgery. Your uterus is filled with a harmless liquid
to make the procedure easier. The lining of the uterus is then burned
away or vaporized, using a heat generating tool inserted through the
viewing tube.

Your physician may decide to perform a laparoscopy at the same time
to rule out other conditions that could require further therapy.

Afterwards


Your doctor may advise you to:
-Avoid strenuous activity for a period of time, usually 24 hours
following the procedure.

-Refrain from sexual intercourse for a specified period, usually 2
weeks or until the discharge stops.

-Schedule an appointment for about a week after your surgery.




In addition, you may experience some of the following:

-Frequent urination during the first 24 hours; this is normal.

-A small amount of bloody, watery discharge for up to 6 weeks
following the procedure. It is impossible to evaluate the
effectiveness of your surgery until at least three months
postoperatively.

-Some cramping, for which your doctor may prescribe or recommend pain
medication. Many over-the-counter medications such as Motrin, Aleve,
Advil or Nuprin.

-The anesthesia may cause mild nausea and vomiting.


Rarely, more serious problems such as cardiac arrest (heart stoppage)
and pulmonary arrest (no breathing) have been caused by general
anesthesia.

Rarely, the viewing tube can puncture the uterus and injure the
bowel. This seldom happens, but if it does your physician will
generally stop the procedure and postpone it until the puncture heals
by itself. Another possible risk is fluid overload. If your body
absorbs too much of the liquid used to fill up your uterus during the
operation, the procedure will be discontinued.

It is unlikely that the operating tool will puncture the thick
uterine wall, but this is a potential risk.

The bowel could also be damaged by heat from this tool. Infections
developing from either of these rare complications could require
additional surgery.
---
Information about ThermaChoice™

What is ThermaChoice™ Uterine Balloon therapy?
This is a new outpatient procedure approved by the FDA to reduce
excessive menstrual bleeding. This procedure destroys the lining of
the uterus by the use of heat.

Am I a candidate for ThermaChoice™?
Your physician must rule out abnormal uterine conditions like some
fibroids, and your pap smear and biopsy must also be normal. (This
treatment is not for uterine cancer. If you still want to have
children, ThermaChoice is not an option since the uterine lining is
destroyed during therapy.)

What can I expect from ThermaChoice™?
In most cases, bleeding during your period will be reduced to
moderate or light flow. Some women may have spotting and a few may
experience no bleeding at all. Data has shown that up to 15% of
patients may not respond to ThermaChoice and may require additional
treatment.

How does ThermaChoice™ work?
First a soft flexible balloon attached to a thin catheter is inserted
into the vagina through the cervix and placed into the uterus. Then
the balloon is inflated with a sterile fluid which expands to fit the
size and shape of your uterus. The fluid in the balloon is heated
to 87°C or 188°F and maintained for eight minutes while the uterine
lining is treated. When the treatment cycle is complete, all the
fluid is withdrawn from the balloon and the catheter is removed.
Nothing stays inside your uterus. Your uterine lining has been
treated and will slough off like a period for the next 7 to 10 days.

What will I feel during the procedure?
Before the procedure, your physician may give you a medication to
minimize cramping during and after the procedure. You may also be
given a mild sedative to help you relax. In some cases the patient
will be awake during the procedure with the use of local anesthesia.
Some patients prefer to be asleep using a general anesthetic. These
options should be discussed with your doctor.

What will I feel after the procedure?
There may be mild or moderate cramping like a menstrual period, and
if needed, your physician may give you medication to make you more
comfortable. After one to four hours in recovery, you should arrange
to be driven home where you can rest for the remainder of the day.

What happens after I go home?
Most women can return to work and family commitments by the next
day. Sexual activity can be resumed after your first check-up,
usually 7 to 10 days. Most patients have a pinkish, watery, vaginal
discharge for about two weeks but sometimes it may be a month. In
some cases, the first few periods after the procedure may continue to
be heavy but will begin to improve thereafter.

What about complications after I get home?
Call your physician if you develop a fever of 100.4°F or over,
worsening pelvic pain that is not relieved by ibuprofin or other
medication that has been prescribed by your physician, nausea,
vomiting, bowel or bladder problems, and/or a greenish vaginal
discharge.

What are the expected results from this procedure?
Approximately 30 per cent of women undergoing this procedure
experience amenorrhea (no period), another 30 per cent of women will
have hypomenorrhea (spotting or light period only), 25 per cent will
have eumenorrhea (normal period) while 15 per cent will have no
improvement.

What are the risks of ThermaChoice™?
The procedure may pose some rare risks including blood loss, heat
burn of internal organs, electrical burn, perforation or rupture of
the wall of the uterus, or leakage of heated fluid from the balloon
into the cervix or vagina. Collection of blood or tissue in the
uterus and/or fallopian tubes during the months post-procedure is
also possible and may require an outpatient procedure to correct the
problem. As with any type of uterine procedure, there may also be
the risk of infection, usually easily managed with oral antibiotic
therapy.

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2092 A on ICQ

 

 

evile: howdy. I have phone duty, yay.
SkyeDS: mornin :) I'm fighting w/ WP because it's doing things I've
never seen it do before (in more than a decade of exp w it)
evile: bizarre.
evile: I'm just fighting with bizarre callers who don't have a clue
what they're doing and think I can just materialize things out of an
orifice.
SkyeDS: lol
evile: Or think that since they got transferred from another TWC
worker, that I already know everything about them through some kind
of TWC osmosis.
evile: I don't have as much patience with people as I should today.

evile: Im just waiting to get out of here & get stuff done at home so
I can go to poly dinner with a clear conscience :)
SkyeDS: I'm happy I don't have to have patience with people very often
SkyeDS: all I have to do is fend off the stupid doctors
SkyeDS: and playing stupid myself tends to do that pretty well
evile: yup :)
evile: playing stupid is so helpful. I wish I'd learned how to do it
ages ago.
SkyeDS: I don't manage it well past a saccharine "may I take a
message?" and "no, I'm sorry, that's just not possible" and brief
explanations that constitute blowing smoke up client's ass
SkyeDS: I don't like doing it, but a good number of our clients think
they are our only clients and try to micromanage, so it is my job to
insulate and protect Hugh from them so he can get work done
evile: yeah. People are sometimes surprised to discover that they
aren't the only unemployed people in TX when they call & talk to me.
amazing.
SkyeDS: lol
evile: Yes, sir, you and 39,000 other people are waiting for a
hearing. We are working the hearing officers like dogs. You will get
a hearing as soon as we can schedule one for you...
evile: lordy.
evile: The good thing about phone duty is I get to leave an hour
early :)
SkyeDS: good trade
evile: yeah. Most days it's not so bad. Some suck. Today wasn't bad,
just busy.
evile: OMG--people are already yapping about whether or not we're
getting all or part of Good Friday off at the last minute (sometimes
the Gov lets us off, but we never know until the actual day)
evile: who cares? it's WEDNESDAY, get to work!!! (i hates them)
SkyeDS: lol
evile: I kept having to keep myself from telling people 'have a nice
weekend' on phone duty. It's _my_ Friday, but not necessarily
theirs :P
SkyeDS: hehe
evile: I went and bought about 6 movies for my recovery. I can't wait
to sit around on the couch watching movies & doing nothing. Isnt'
that awful?
SkyeDS: no eating?
evile: No eating after midnight tonight. I should be Ok after surgery.