Endometrial Ablation for Menorrhagia

Healthcare Professionals

Approximately 2.5 million women each year in the United States seek medical treatment from their gynecologists for excessive uterine bleeding. Excessive uterine bleeding also called irregular bleeding, menorrhagia, and dysfunctional uterine bleeding is defined as total blood loss exceeding 80 ml per menstrual cycle or prolonged bleeding beyond seven days. Excessive uterine bleeding is considered a symptom of anatomic irregularity, hormonal imbalance or a systemic disease. Commonly, however, it is the result of disorders within the uterus itself, such as fibroids or polyps and, more rarely, endometrial cancer. Excessive uterine bleeding can also be caused by other factors, including medication side effects from post-menopausal hormone replacement therapy, miscarriage and retained tissue after child birth.

Hysterectomy has historically been the ultimate solution offered for long-term relief to women who continue to bleed despite hormonal therapy or Dilation and Curettage(D&C). Of the approximately 600,000 hysterectomies performed annually in the United States, it has been estimated that more than 150,000 are performed for the relief of heavy bleeding from benign causes*. Considerable public attention has been focused on the frequency with which hysterectomy is performed, suggesting that many of the procedures for benign conditions may be addressed with less invasive alternatives which may offer:

• An outpatient procedure
• Decreased recovery period and less need for general anesthesia
• Fewer significant harmful side effects

The Hydro ThermAblator® System is a hysteroscopic thermal ablation device intended to ablate the endometrial lining of the uterus in pre-menopausal women with menorrhagia (excessive uterine bleeding) due to benign causes for whom childbearing is complete.

Pre-Operative Procedures
The endometrium should be in a basal state prior to Hydro ThermAblator System (HTA System) treatment. This can be accomplished by timing the menstrual cycle to the early proliferative phase or administering pre-treatment drugs such as danocrine or GnRH agonists prior to performing the endometrial ablation. The optimum pretreatment regimen has not been determined at this time. As with any hysteroscopic procedure, the bladder should be empty. The usual vaginal preparation for hysteroscopy shall be employed.

It is recommended that a non-steroidal anti-inflammatory drug (NSAID) be given at least one hour prior to treatment and continued post-operatively as necessary to reduce intra-operative uterine cramping.

Steps of the Procedure
The HTA System allows less invasive treatment of Menorrahagia. because the treatment relies on the circulation of heated saline that fully conforms to the entire endometrial lining – including the corneal areas. Patients with a partial septate uterus or intra-mural fibroids ≤ 4cm, may generally be treated. The illustrations show the 3 basic steps of the procedure:

• (Figure 1) The gynecologist inserts a small probe into the uterus that includes a tiny telescope to allow visualization of the uterine cavity while room temperature saline solution is circulated through the uterine cavity.
• (Figure 2) The fluid is then gradually heated to treat the lining of the uterus (the endometrium); the change in color of the lining shows the effect of the treatment.
• (Figure 3) At the completion of the treatment phase, cool saline solution replaces the heated fluid and then the instrument is removed.

Post-Operative Procedures
Patients generally return home the day of the procedure. Cramping can be expected to be moderate to severe post-operatively, usually resolving itself by evening. Vaginal discharge is typically experienced during the first few days following ablation and may last as long as a few weeks. Generally, the discharge will be bloody during the first few days, then serosanguinous at one week post treatment, and watery thereafter.

*Article:Endometrial Ablation: More Choices, More Options by James F. Carter, MD

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