Endometrial Ablation Procedure

 If you are experiencing heavy bleeding with your periods, please take a moment to read through the following information on a simple procedure called endometrial ablation.  If you are seeking relief from heavy menstrual bleeding call and make an appointment with one of our physicians to see if Endometrial Ablation is right for you.  One of our physicians would be happy to sit down and evaluate your specific history to see if this simple in-office procedure is right for you.  Most insurances cover this procedure.   It can be done most of the time in our office and in under 1 hour of your time.  Our insurance specialists can pre-authorize this with your insurance once you and your doctor have decided this procedure is right for you.

Endometrial Ablation Patient handout - English
Endometrial Ablation Patient handout - Español

MENORRHAGIA - HEAVY MENSTRUAL BLEEDING

At some time in your life you’ve probably experienced heavy bleeding during your menstrual cycle. Some women have heavy periods almost every cycle. Menorrhagia is the medical term for excessive or prolonged menstrual bleeding.

Menstrual cycles are not the same for every woman. Normal menstrual flow occurs every 21-35 days and usually last 4 to 5 days with a total blood loss of 30-40ml, about 2-3 tablespoons of non-clotting blood and endometrial debris. With each cycle the lining of the uterus, the endometrium, builds up and is shed off. Menorrhagia refers to loosing 80ml, 6 tablespoons or more of blood during your menstrual cycle.

I DESCRIBE MENORRHAGIA AS BLEEDING THAT INTERFERS WITH YOUR QUALITY OF LIFE. It can be draining and debilitating. Excessive bleeding can cause anemia and fatigue, and can interfere with everyday activities. It can affect your ability to do the things you need to do.

THE SIGNS AND SYMPTOMS OF MENORRHAGIA MAY INCLUDE:

  • • YOUR MENSTRUAL CYCLE CONTROLS YOUR LIFE

  • • YOU LIMIT YOUR ACTIVITIES DURING YOUR PERIOD

  • • YOU BECOME WEAK OR TIRED DURING YOUR CYCLE

  • • MENSTRUAL CYCLES THAT SOAKS THROUGH ONE OR MORE
  • • SANITARY PADS OR TAMPONS IN AN HOUR

  • • NEED TO CHANGE SANITARY PROTECTION DURING THE NIGHT

  • • THE NEED FOR DOUBLE SANITARY PROTECTION

  • • MENSTRUAL PERIODS LASTING LONGER THAN 7 DAYS

  • • MENSTRUAL FLOW THAT HAS LARGE BLOOD CLOTS


If you have any signs or symptoms of menorrhagia you do not need to continue living with this heavy bleeding.
 

WHY ARE MY CYCLES SO HEAVY OR SO FREQUENT ?

There are many causes of menorrhagia. Women who have heavy periods can have the cause diagnosed in 1 or 2 office visits. Once you know why your bleeding is excessive, you can decide which treatment is best for you.

• HORMONAL IMBALANCE
• FIBROIDS
• ADENOMYOSIS
• ENDOMETRIAL POLYPS
• UTERINE CANCER
• CERVICAL POLYPS
• CERVICAL CANCER

OTHER CAUSES OF ABNORMAL BLEEDING
• Thyroid disease
• Blood coagulation disorders
• Pregnancy complications
• Ovarian cysts
• Vaginal lesions
• IUD
• Medications
• Medical condition

DIAGNOSING BLEEDING


The cause of abnormal bleeding can be diagnosed by an exam, and a few simple tests done in the office.

BLOOD TESTS
CBC, TSH, HCG, Blood clotting tests

PAP SMEAR
check for cervical problems

ULTRASOUND
evaluate the uterus and ovaries

HYSTEROSCOPY
evaluate the inside lining of the uterus

ENDOMETRIAL BIOPSY
- biopsy the lining of the uterus to diagnosis endometrial cause of bleeding, rule out cancer

You can schedule the ULTRASOUND and after that an appointment for the HYSTEROSCOPY/ENDOMETRIAL BIOPSY. These can be done on the same visit. The ultrasound will take about 15-30 minutes. Hysteroscopy/endometrial biopsy also takes about 15 minutes. Ibuprofen prior to your appointment will help prevent cramping from the biopsy.

PRIOR TO THE HYSTEROSCOPY/ENDOMETRIAL BIOPSY:

IBUPROFEN 800mg
- at bedtime the night before the procedure
- one hour prior to your appointment
- upon waking the day of your appointment
for afternoon procedures

EAT NORMALLY BEFORE YOUR PROCEDURE , YOU SHOULD HAVE SOMETHING IN YOUR STOMACH WHEN YOU TAKE YOUR IBUPROFEN

TREATMENT OF MENORRHAGIA

• NONSTEROIDAL ANTI-INFLAMMATORY DRUGS
    - helps reduce menstrual blood flow

• ORAL CONTRACEPTIVES
    - may control bleeding do to hormonal causes

• PROGESTERONE
    - can help correct hormonal imbalance

• MIRENA IUD
    - progesterone to decrease bleeding

• DEPO-PROVERA
    - progesterone shot that lasts 3 months

• LUPRON
    - a temporary menopause

• ENDOMETRIAL RESECTION
    - surgical procedure to treat specific intrauterine pathology

• ENDOMETRIAL ABLATION
    - office or outpatient procedure to remove the lining of the utereus

• UTERINE ARTERY EMBOLIZATION
    - hospital procedure to block the uterine arteries

• MYOMECTOMY
    - removal of fibroids

• HYSTERECTOMY
    - removal of the uterus

SPECIFIC TREATMENT FOR MENORRHAGIA IS DEPENDENT ON:

• Your health and medical history
• Your ability to tolerate medications
• Your severity of bleeding
• Your cause of bleeding
• Your acceptance of the risks and success of the treatments
• Your personal preference
• Any other gynecologic problems (prolapse, urinary stress incontinence, pain, family history of uterine or ovarian, cancer)

ENDOMETRIAL ABLATION

A quick, simple office procedure for the treatment of heavy or prolonged bleeding.

Endometrial Ablation is the removal of the inside lining of the uterus. This lining, the endometrium is built up with each cycle and shed during menstration. The ablation cauterizes the lining and the blood vessels supplying the endometrium. Some women will no longer have any bleeding, most will have a significant decrease in their menstrual flow, and a few may not have a change in their cycle.

Endometrial Ablation does not require hospitalization, and most women are able to return to normal activities the next day. This does not affect your hormones, it will not cause you to go through menopause. If you desire to get pregnant in the future you should not have an ablation. This is a permanent procedure that can not be reversed, however it is not a form of birth control, and birth control is absolutely necessary. The endometrial lining is necessary for a healthy pregnancy, so after an ablation you should not become pregnant.

The cause of your abnormal bleeding will be diagnosed by an exam and a few simple tests in the office. You may have a PAP SMEAR, some blood tests, ULTRASOUND, and a HYSTEROSCOPY/ENDOMETRIAL BIOPSY done to determine what is the best treatment for your bleeding. This will enable us to see if you are able to proceed with an office endometrial ablation.

You will be given some medications to take the evening and morning before the procedure. It is extremely important to take these medications as directed, they will make the procedure easier for you, and help decrease the amount of cramping and pain you experience after the ablation. The procedure takes less than 15 minutes, but you will be in the office about an hour. Prior to the procedure you will have an injection of Toradol that will help with cramping and a local anesthetic to reduce pain. You will need to have someone drive you to the office and take you home.

Eat a light breakfast in the morning or a light lunch for the afternoon procedures and drink plenty of fluids. Have something in your stomach when you take your medications.

After the procedure you should continue your pain medications for the first 24 hours. Pain medications work better at preventing pain than trying to catch up after you have pain.

PRE PROCEDURAL ENDOMETRIAL ABLATION INSTRUCTIONS

ARRIVE AT THE OFFICE 30 MINUTES PRIOR TO YOUR PROCEDURE

COME TO THE OFFICE AT ______________________________
YOUR ABLATION IS SCHEDULED FOR___________________

Eat lightly before your procedure. You should have something in your stomach when you take your medications.

Prior to the procedure we will have you take these medications.

CELEBREX 200mg - 2 tablets orally at bedtime the night prior to the procedure
- 2 tablets orally 1 hour prior to your appointment
- 2 tablets orally in the morning the day of your procedure if its
scheduled for the afternoon

VALIUM 10mg - 1 tablet orally 1 hour prior to your appointment

VICODAN ES - 2 tablets orally 1 hour prior to your appointment

HAVE SOMEONE DRIVE YOU TO AND FROM THE OFFICE

Upon arrival to the office you will be given an injection of Toradol, a medication that will help with cramping. This is given about 30 minutes prior to the ablation.

A local anesthetic will be given about 15 minutes prior to the procedure.

The Ablation should take about 15 minutes to perform. You may have some cramping during the procedure, but is usually very tolerable. We will talk with you during the procedure and answer any question you have.

POST PROCEDURAL ENDOMETRIAL ABLATION INSTRUCTIONS


YOU MUST HAVE SOMEONE DRIVE YOU HOME FROM THE OFFICE

CONTINUE TO TAKE YOUR PAIN MEDICATIONS FOR 24 HOURS AFTER THE PROCEDURE TO PREVENT PAIN AND CRAMPING.

DISCOMFORT is usually the most significant in the first 2 – 6 hours after Endometrial Ablation. A heat pad can provide additional relief.

FEVER may be a sign of infection. If you experience chills, feel feverish, or just don’t feel good, take your temperature immediately. Call us if your temperature is 100.5 or higher.

NAUSEA may occur after the procedure. It is usually cleared with fluids or soda. If it worsens or you start vomiting you may take the medication prescribed.

DIET is unrestricted, start off slowly to make sure you have done okay with the medications we have given you.

WORK may be resumed the day following the procedure if you feel up to it.

DISCHARGE following this procedure can vary. It can be light to heavy. It can be like a menstrual period. It is common to have a watery pinkish discharge for 3 – 5 days after the procedure, and then a brownish/bloody discharge for 1 – 2 weeks. There can be some thicker endometrial type discharge also. If you have minimal or no discharge that to is normal.

INTERCOURSE may be resumed 1 week after the procedure.


 






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