Ablation not Hysterectomy

Your Doctor Suggests an Ablation…What Does That Mean?

There are over 600,000 hysterectomies performed in the United States each year.  Some hysterectomies are elective and some emergent, some abdominal and some laparoscopic, with some patients requiring follow up hormonal therapy at some level. The patient’s general health and cancer status in many cases confer hormone therapy as a possible option.  Whether a woman proceeds to hysterectomy or not, menopause and its associated symptoms become evident in many women and hormone therapy may be necessary for some patients.

Often the hysterectomy is a result of a diagnosis of severe endometriosis, uterine fibroids, uncontrolled bleeding, pelvic prolapse and even cancer.   There can be other factors but these are the most common.   Many physicians believe that a hysterectomy is a dangerous surgery and that it should only be performed if all other options have been considered. The diagnosis of cancer is always an exception to this premise.  For some time now an interim method for surgical intervention to control bleeding was sought and finally developed. Many methods of endometrial ablation of the uterus now exist and should be considered as a possible initial option.

Endometrial Ablation is an alternative therapy to hysterectomy and is a procedure where the cells of the uterine lining are destroyed.  Only women beyond child bearing or no longer desiring to bear children are candidates for ablation.  Once the cells are destroyed a fetus cannot attach. Non-the-less, it is NOT a birth control measure. Caution must be taken to assure that a pregnancy does not occur following the procedure as most of these pregnancies are not properly implanted and can result in miscarriage without the ability to surgically evacuate the uterus following such a procedure, says Suzanne Lowry MD, Medical Director of West Atlanta Gynecology in Atlanta, Georgia.  All patients are counseled regarding this risk. According to Dr. Lowry, the ideal patient either has already had a tubal ligation or her partner has had a vasectomy.

There are many different ablation techniques and procedures and we will highlight the most common here.  There exists both hysteroscopic and nonhysteroscopic techniques. The endometrial cavity and uterine size and other pathologies should be defined via ultrasonography preprocedure.  When necessary, endometrial sampling to assure the absence of cancer should be also performed prior to the procedure.

The following is a brief discussion of three of the most common ablation techniques. The Nova Sure 90 second Ablation procedure is very popular and is the latest and fastest method.   Down time is relatively short also with this procedure and most women can resume normal activities within a few days.   The procedure consists of light anesthesia, followed by the inserting the Nova Sure device into the uterus.  The device is activated from the outside and will turn itself off when the procedure is complete.   The advantage of this system is that no hormonal therapy is needed prior to the procedure to wear down the lining.  Most women also can go home within a couple of hours of their ablation.  Compare this to 3 to 4 hours of surgery for a difficult hysterectomy and four to six weeks of recovery.

The GYNECARE Thermochoice procedure also uses a device and is recommended for premenopausal women who have completed their families and are not going to want to be pregnant in the future. This procedure additionally requires post-procedure contraception as none of these confers infertility.

HerOption Cryoablation Therapy is another method that uses very low temperatures to remove the lining of the uterus.   The extremely low temperatures required to accomplish this procedure aids in providing procedural “additional” anesthesia.

All three techniques have advantages and disadvantages relative to one another and different statistical results. All are effective in diminishing the volume and length of the menstrual cycle.

Here, Dr. Erika Schwartz gives several reasons why you shouldn’t have a hysterectomy: