ENDOMETRIAL ABLATION
Over the past decade, a technique has
been developed that can reduce or stop your periods without a hysterectomy. This surgery
can be done in women who have flooding either with or without fibroid tumors. Dr. Dott was
one of the surgeons who introduced this minimally invasive procedure in Atlanta. He has
performed this procedure many times and is certified by the Accreditation Council for
Gynecological Endoscopy in Advanced Hysteroscopic Surgery. He has been taught his
procedure in training institutions both in the United States and Russia
This technique is called a hysteroscopic endometrial
ablation or "roller ball surgery". Patients who have had this procedure have
been followed for up to 10 years. During this period of time, they have enjoyed either
complete, or almost complete, cessation of menses in over 90 percent of the cases. Roller
ball is done under general anesthesia or regional block (spinal or epidural). This is the
outpatient procedure. Hospitalization is not necessary, except in rare instances.
Following the procedure, patients note a brownish to slightly bloody discharge, which
occurs shortly after the procedure, and last up to 6 weeks. Patients are advised to
refrain from any kind of exercise for at least 3-4 weeks because there have been reports
of heavy bleeding following strenuous exercises(i.e., moving furniture, cutting wood,
jogging). Half the patients will experience no side effects with the cautery technique,
and are back to normal activity within 2-3 days: the other half will notice a cramp-like
sensation, and are tired for several days. Over 90 percent of the patients are back to
normal activity within 4-5 days after surgery. Most patients take 4-5 days off work
following their surgery, although some individuals have returned to work within 24 hours.
This operation may cause sterility, but it is not
guaranteed. However, if you choose to be permanently sterile, a tubal ligation should be
performed. Prior to using either cautery technique, it is important that the menstrual
cycle be modified. This is achieved by taking tablets called Danocine or Provera.
Danocrine is a medication usually used for a
condition called endometriosis. Generally, 2-4 pills a day are taken for 6 weeks. The side
effects of Danocrine include weight gain, growth of hair, acne, and general malaise. The
side effects of Provera include slight weight gain, depression, and PMS like symptoms. The
third approach is an anti-hormone shot called Depo-Lupron. This medication causes a state
of temporary menopause with hot flashes, vaginal dryness, and sleep disturbances. Because
Depo-Lupron is quite costly ($500/month for 2 months), it is not used as often for
preparation for this procedure. Following the cauterization of the uterine cavity,
patients are often given an injection of a long-acting progesterone called Depo-Provera.
The shot will last approximately 3 months. During this time , a rare patient may
experience mild depression. Bleeding is generally reduced when this medication is used
post-operatively.
In virtually every case treated to date, there is
either reduction or cessation of the menstrual flow. However, it takes 1 to 11/2 years to
know exactly what the final results of the treatment will be. The complications of
cauterization of the uterine lining include the risks of anesthesia and perforation of the
uterus. A large volume of fluid is used during the procedure, and there is a rare chance
of absorption of this fluid with mild alteration in blood products, i.e. electrolytes. The
risk of perforation of the uterus is rare primarily because of the modifications that we
now employ in performing the technique. Out of the first 100 women having this procedure,
only 4 returned for a hysterectomy or more extensive gynecological surgery. 96% of the
candidates were spared more extensive surgery.
This procedure has fewer surgical risks than a
hysterectomy and provides an option to hysterectomy for stopping or reducing menstrual
flow or for removing small fibroids or polyps while preserving a young woman's fertility.
|