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Global Endometrial Ablation for Abnormal Bleeding:
New Solution to Old Problem

 What is Global Ablation?woman_w_lightbulb

Removal of the uterus lining (endometrium) to reduce heavy periods.

How Successful are Global Endometrial Ablation Procedures?

  • Ninety percent of women report long-term (at least five years) satisfaction with their ablation procedures.
  • In women 45 years or over greater than half will have no periods after an ablation procedure–the remainder will have significantly reduced bleeding. Women under 45 are more likely to continue to have periods but they are generally half to two-thirds lighter and shorter.
  • About 10-20% of women will continue to have heavy periods after an ablation procedure, depending on the original cause of their bleeding.

Advantages of Global Ablation Procedures

  • Safer than hysterectomy (complication rates 0.1% versus 5 to 10% for hysterectomy)
  • Does not affect hormone levels
  • Cheaper than hysterectomy
  • Less down time from work compared to hysterectomy (1 day versus 6 weeks)
  • Can be performed in the office with minimal anesthesia
  • Can be combined with other modalities (e.g. aromatase inhibitors) to optimize minimally invasive treatments for fibroids

Endometrial ablation and sustainable health care 

From 2001 to 2007, after the introduction of global ablation procedures, hysterectomy rates in the state of California dropped 17%, making endometrial ablation an excellent example of sustainable health care.

Endometrial ablation done in the office with conscious sedation costs a few thousand dollars compared to hysterectomy which costs a range of $20,000 to $40,000 (hospital costs, supplies, anesthesia costs, surgeon fee).

Types of Ablation Procedures

Hydrothermablation

image

  • Water circulated at 90 degrees Centigrade for 10 minutes to remove the lining
  • Can treat submucus myomas (fibroids) up to 3-6 cm; irregular cavities, cavities larger than 10 cm
  • FDA approved 2001

Cryoablationimage

  • Freezes the uterus lining to minus 100 to minus 120 degrees Centigrade at tip
  • Requires 2 treatment cycles, 4-6 minutes each; requires little anesthesia
  • Can treat irregularities in cavity, 10 cm max depth
  • FDA approved 2001

Thermachoice Balloon Ablationimage

  • Central element heats liquid circulated in balloon
  • 87 degrees C for 8 minutes
  • Limitations: uterine cavity size 6-10 cm; can’t treat submucous myomas (fibroids just deep to the uterus lining)
  • FDA approved 1997, less commonly used than the other techniques described here.

Radiofrequency (electrocautery) Ablation

image

  • 2 minutes once 50 ohms electrical impedance of tissue reached
  • Can treat normal size uterus
  • Can’t treat large uterus or irregularities (polyps, fibroids)

Microwave Ablation image

  • Treatment temp 70 degrees C
  • Treatment time 6 minutes
  • 10 cm cavity max
  • Can treat small irregularities (fibroids)
  • Available 2003

What’s Your Experience?

  • Have you had a global ablation procedure?
  • How satisfied were you with it?
  • What are the pros and cons for you?
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{ 3 comments… add one }

  • Jayne November 16, 2009, 1:13 pm

    I had the Hysteroscopy NovaSure Ablation done on Friday Nov. 13, 2009. Do not know if my periods will stop completely or not yet. Will take time to find out, I am hoping so as they were getting so bad and I never knew when it would start or stop.
    Procedure was very easy. I had it done in a hospital setting with just sedation. Also had a D&C with it and polyp removal before they did anything.

  • Mechelle July 13, 2010, 5:54 am

    I had my endometrial ablation almost a week ago. So far so good! Absolutely NO pain, little bleeding. Hoping all will be well in future.

  • Connie November 17, 2011, 12:23 pm

    I had the NovaSure procedure done 4 weeks ago and could not be happier!The procedure it self went great with little discomfort after and no bleeding since.Compared to 60 day periods with 5-10 days between this is wonderful!!!

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