In-office Permanent Treatment for Menorrhagia (heavy menstrual bleeding)

Heavy menstrual bleeding or menorrhagia, affects  one out of every 3-5 women. Many women suffer needlessly hoping that menopause will come soon.  Now there is an office procedure that will permanently decrease their menstrual flow and may even eliminate it altogether without affecting their hormone levels. There are no incisions, meaning a quick recuperation and return to normal activities.

The procedure is called an “Endometrial Ablation”.  This is one of the latest tools for the gynecologist that has dramatically reduced the number of hysterectomies previously performed for menorrhagia. Nowadays many women do not want their uterus removed simply to control heavy menstrual bleeding. This procedure specifically targets and ablates (destroys) the endometrium or lining portion of the uterus which is responsible for the monthly menstrual bleeding. The myometrium (muscle portion of the uterus), cervix, tubes, and ovaries are neither removed nor disturbed by this procedure. (See uterus diagram).

To be eligible, women must have completed their childbearing; have a normal endometrial biopsy; and a uterus of sufficient size/architecture to undergo the procedure. (Women with very large fibroids that distort the endometrial cavity do not have the same rates of success although smaller fibroids are often amenable to the procedure).

The most common procedure performed is the NovaSure type ablation. This uses an expandable array to ablate the endometrium. It is microprocessor controlled to ensure uniform treatment of the endometrium and will shut itself off when the tissue resistance indicates a complete treatment. Treatment time averages 90 seconds, (although equipment set up will take longer).

Women are generally given pre-operative sedation with Valium and Vicodin, an injection of Toradol at the office; as well as a paracervical anesthestic. (This involves using local anesthetics lidocaine and bupivicaine in the paracervical tissues).  Because of the sedation, it is recommended that a friend or family member be available to drive.

While no treatment is perfect, endometrial ablation offers 95% improvement with up to 40% of women achieving amenorrhea (no periods at all). The minimal investment in downtime and recuperation is well worth the potential life changing reward of freedom from heavy menstrual bleeding.

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