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Heavy Bleeding, Hysteroscopy, and Endometrial Ablation

hysterscopyWomen who experience severe uterine bleeding have a really rough time.  Their bleeding can be so heavy that it interferes with quality of life.  Usually when we tackle gynecological issues like severe uterine bleeding we, as doctors, try the simplest thing first.  Some ladies respond great to medications and less-invasive treatments, but some ladies do not and they still continue to suffer from prolonged, heavy bleeding.  Some ladies experience such heavy bleeding to the point where it begins to affect their health and well being. These women have unpredictable bleeding, prolonged bleeding, and bleeding that doesn’t respond to medical treatment.

When they get to this point where it seems like no treatments are working anymore, many ladies choose to get a hysterectomy and remove the uterus completely.  No more uterus, no more bleeding.  But for ladies who want to keep their uterus as long as possible, there is another option.  It’s kind of a two-step treatment:  the first is an exam called a hysteroscopy, the second is a procedure called Endometrial Ablation.

A Hysteroscopy is a non-surgical procedure that lets us visualize the interior of the uterus; it can determine if the uterine lining is abnormally thin/thick or if there are any abnormalities present, like a polyp or fibroid, or anything abnormal that might be causing the severe bleeding. (Your gynecologist can perform this procedure in office, or it can be done in an outpatient setting.  And most of the time a regular ultrasound will be done briefly before the hysteroscopy in order to determine the position and tilt of the uterus.)   During the hysteroscopy, an instrument with a light on the end (the hysteroscope) is inserted up into the uterus so your doctor can get a better sense of what tissues look like inside your uterus.

After the hysteroscopy, the second step is a treatment called Endometrial Ablation.  Essentially, the inside lining of the uterus is damaged to a point where it can no longer cause bleeding.  The goal of Endometrial Ablation is to stop bleeding entirely, but the 90-95% of women who are satisfied with Endometrial Ablation are happy even if their bleeding hasn’t stopped entirely. Oftentimes, a dramatic reduction in bleeding is enough to completely change a woman’s quality of life.  And that’s what we’re going for– improving quality of life.

Please note, Endometrial Ablation should NOT be used to treat pelvic pain.  And this procedure should only be done on women who are 100% positive they no longer wish to have children.   If you suffer from pelvic pain or still want to try and have children, you will want to consider other forms of treatment, which I am happy to discuss with you at any time during an office visit.


Posted in Diagnosis, Diseases and Conditions, Fibroids, Heavy Bleeding, Procedures, Treatments

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