Menorrhagia Relief

The global endometrial ablation option
Author: Sarah Aldridge
For some women with heavy menstrual bleeding, or menorrhagia, there is another option that can be considered before hysterectomy. Studies by researchers at the Mayo Clinic in Rochester, Minnesota, have demonstrated the safety and effectiveness of global endometrial ablation (GEA), a procedure that destroys the endometrium, the lining of the uterus shed during monthly menstruation.

In an April 2010 study in the American Journal of Obstetrics & Gynecology, researchers, led by Sherif El-Nashar, MBBCh, gathered data from surveys of 41 women with bleeding disorders and 111 without, all of whom had undergone GEA.

“We asked the patients about their satisfaction with the results of the ablation and to rate it,” says Abimbola Famuyide, MBBS, one of the authors. He is a gynecologic surgeon and chair of the gynecology department at the Mayo Clinic. “About 95% of the patients in the bleeding disorders group were very satisfied or somewhat satisfied with the procedure versus about 84% in the nonbleeding disorders group.” Duration of menstrual bleeding and the number of pads or tampons used on the heaviest days were also measured. “Both of those showed significant reductions.”

Several types of GEA have been approved by the US Food and Drug Administration (FDA) that use various energy forms: freezing; radio-frequency; heated fluid or a balloon filled with a heated solution; and microwave. A probe inserted into the uterus destroys the endometrium. As the uterus heals, it develops scar tissue, which reduces or prevents menstrual bleeding.

The procedure is short and can be done on an outpatient basis at a surgery center under light anesthesia or in a doctor’s office under local anesthesia, says Famuyide. “The radiofrequency device averages about 90 seconds’ actual treatment time. It takes about 14 minutes for the hydrothermal ablator, which uses hot water that’s distilled into the uterus.” Most patients are homeward bound within two hours after surgery. Cramping and bleeding are typically minor. “They are able to resume normal activities almost immediately without any restrictions,” Famuyide says.

Depending on the type and severity of your bleeding disorder, clotting factor may be needed before, during or after the procedure. Your hematologist should work with your surgeon to determine your need for factor.

Alternatives Before Ablation

Because GEA can permanently halt menstruation, causing sterility, reproductive-age women with menorrhagia may want to consider other treatments first. “Once you destroy the lining of the uterus, pregnancy after that is less likely to occur,” Famuyide warns. “If it does, it is more likely to be complicated, either in terms of miscarriage or restricted growth of the fetus.”

If menorrhagia is disrupting your life, talk to your hematologist about options. “The goal of global endometrial ablation is a reduction in menstrual blood flow to allow an improvement in the quality of life of the woman,” Famuyide says.