It is no secret that the menstrual period can be an extremely difficult time for any woman to deal with. One of the biggest frustrations can be the bleeding that comes with menstruation as the uterus sheds a layer of endometrium that has built up since the previous cycle. In certain situations, heavy menstrual bleeding can occur that lasts longer than normal, which further adds to the difficulty of going through menstruation. This condition, known as menorrhagia, can be treated with a relatively simple in-office procedure known as endometrial ablation. 

In the female anatomy, the inner wall of the uterus is lined with a substance known as endometrium. During menstruation, the endometrium gradually thickens and is shed in the form of bleeding. In certain conditions, such as menorrhagia, this bleeding can be abnormally heavy. Additionally, certain conditions affecting the endometrial lining can cause irregular periods. In situations such as these, a common treatment is to remove the endometrium through endometrial ablation. Another more invasive option is the complete removal of the uterus with a hysterectomy procedure.

Endometrial ablation is the procedure in which the endometrium that lines the uterus is removed. The procedure is most commonly performed as an outpatient treatment with a minimal recovery time and is a good alternative to a regular hysterectomy in the treatment of heavy menstrual bleeding.

According to OB/GYN Dr. Dennis Eisenberg, affiliated with Baylor Medical Center of Plano, “Women with heavy menstrual bleeding, which is referred to as menorrhagia, are often treated with endometrial ablation to improve their quality of life. Additionally, the procedure is used as an elective procedure for women who have already had children or do not want children, but would like to stop having heavy period.”

Endometrial ablation procedures have been used for years to treat irregular bleeding. There are a wide variety of methods for the procedure. Originally, an endometrial ablation was performed through the use of a hysteroscope, a tiny camera used to look into the uterine cavity through the vagina. An instrument would be used to “shave” the uterine wall or a roller electrode would cauterize or burn the inner wall of the uterus, similar to a paint roller on a wall. Newer methods of treatment enable a greater coverage area during the endometrial ablation and reduce both the invasiveness of the procedure and the time it takes to complete.

The balloon method can be accomplished in two ways. In the first type of balloon endometrial ablation, the balloon is inserted in the uterus and filled with fluid, which is heated to remove the endometrium. In the second type of balloon treatment, the balloon has a surface covered with electrodes. A current is run over the surface of the balloon to remove the endometrium.

Another method for endometrial ablation is through the use of microwave technology. A small rod is inserted in the uterus through the vagina and microwave energy is run through the end of the rod, which is swept back and forth across the inner wall of the uterus to remove endometrium. Other methods rely on freezing or laser technology in the removal of endometrium.

Finally, the Novasure ablation provides another option for the treatment of heavy menstrual bleeding. The Novasure ablation is an endometrial ablation system that treats the entire inner wall of the uterus at one time. This is accomplished through the insertion of a skinny metal sheath into the uterus through the vagina. Once the sheath is inserted, a mesh screen is released to cover the entire inner wall of the uterus. An electric current is run through the mesh screen that burns off the endometrium.

According to Dr. Eisenberg, “I use the Novasure ablation system in my office. With the Novasure ablation system, I am able to get up to 95% coverage of the uterus. The process usually takes about a minute and the patient cannot feel anything while the procedure being done.” The procedure is performed under anesthesia provided by an anesthesiologist.

While any medical procedure has a risk of complications, the level of risk for complications from an endometrial ablation procedure is relatively low. These complications include perforation to the uterus, burning of the uterine wall, pulmonary edema, pulmonary embolism, and cervical laceration. While the risk for these conditions is extremely low, if any complications were to occur they could be quite severe.

When considering treatment for menorrhagia, there are a number of options for treatment. Heavy menstrual bleeding can be treated with hormone therapy, a hysterectomy procedure, one of the newer birth control pills, or with an endometrial ablation. Of these treatments, endometrial ablation is the quickest method of treatment, and often the most effective of the conservative treatments. Recovery times for the procedure range from 24-48 hours in most cases.

Additionally, most insurance providers offer coverage for endometrial ablation in the treatment of menorrhagia. Coverage is usually verified before the procedure by the doctor’s office.

Ultimately, there is hope for women suffering from heavy menstrual bleeding. Endometrial ablation offers women the chance to receive treatment that will not interrupt their day-to-day life to a high degree. According to Dr. Eisenberg, “While there are a number of treatments available for menorraghia, modern advances have allowed for women to receive timely treatment for their condition without requiring a long, uncomfortable recovery time.”