Setting An Example For A Healthy Lifestyle

Our Nurse Practitioner Amy Daggett “weighs in”

My relationship with food is a double edged sword. Although I find comfort in creating delicious entrees and desserts, I lacked the will power needed to make healthy food choices. We live in a society where foods with low nutritional values are inexpensive and readily available whereas healthier choices are costly and require preparation. After years of losing this battle, at age 53 I found myself obese and depressed.

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Been Told That You Need An Endometrial Biopsy?

Here are some things to consider

An endometrial biopsy (EB) is often done on women who are undergoing evaluation of abnormal periods or for an infertility issue.

An EB involves the passage of a small instrument into the cervix at which point the lining is randomly scraped and the specimen which is obtained is submitted to lab for analysis. The endometrial biopsy is a screening test for abnormalities such as endometrial hyperplasia (a pre-cancerous condition of the uterus) and endometrial cancer.

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One woman’s experience with endometrial ablation failure

I took a call yesterday from a woman in the southern tier. We get 2-3 of these calls in a typical week from all over the United States. Fortunately this woman lived only a few hours away—for the sake of this article we’ll call her “Bonnie”. I’m writing about her because her’s is a classic case of “late-onset-endometrial ablation failure (LOEAF)”.

Her endometrial ablation was performed 10 year ago with one of the commonly used ablation devices. She did well for nearly 10 years—which is great. Now, at age 39, she reports that beginning in the fall of 2016 she began experiencing a slight bout of abdominal pain.

By December her pain was intense Continue reading “One woman’s experience with endometrial ablation failure”

Life After An Endometrial Ablation

Late-Onset Endometrial Ablation Failures

by Morris Wortman, MD FACOG

Endometrial Ablation (EA) is a widely used minimally invasive technique to manage heavy or abnormal periods. Nearly 500,000 of them are performed in the United States each year. Although EA may not be a perfect answer for everyone suffering from abnormal periods its advantages include the following:

  • It can be performed in a physician’s office,
  • It requires very little time off from work—compared to hysterectomy,
  • It is far safer than hysterectomy

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Recommendations for women who have undergone endometrial ablation and EMR

The Center of Menstrual Disorders announces its official recommendations for women who have undergone endometrial ablation* and EMR

(* includes NovaSure®, Hydrothermal®, ThermaChoice®, “roller-ball”)

It is now well understood that every kind of endometrial ablation (ThermaChoice, Hydrothermal Ablation and NovaSure and “rollerball procedure” as well as Endomyometrial Resection (EMR) is associated with a set of conditions known as LOEAF – late-onset endometrial ablation failure.

Late-onset endometrial ablation failure (LOEAF) is a common condition and affects between 5-40% of women depending on a variety of factors including age (the younger you are the more prone you are to develop this) and other conditions such as fibroids.

LOEAF may take on one of three forms:

  1. Women who have previously enjoyed light or absent periods may slowly develop heavier periods. This generally happens as lining tissue has a tendency to regrow—especially in younger women. In some cases it was not possible to destroy all of the uterine lining.
  2. Central HematometraWomen may develop increasingly painful periods or episodes of pain without accompanying periods known as “cyclic pelvic pain” or CPP. CPP develops as a result of 2 factors—the regrowth of uterine lining and the growth of scar tissue that prevents menstrual blood from passing easily. This combination can lead to a slight increase in cramps at the time of your expected period or it can result in incapacitating “labor-like” pains that occur above the pubic bone (suprapubic), in the right or left lower quadrants or even in the lower back. This pain is typically caused by a hematometraLearn more about hematometra.
  3. The inability of access the uterine cavity should a biopsy be required at some point in your life. This is very important to remember. If you develop post-menopausal bleeding or require assessment of the uterine cavity (for cancer screening) conventional methods of assessment such as ultrasound, sonohysterogram, diagnostic hysteroscopy and endometrial biopsy are no longer reliable. You can see why from the picture above—the uterine cavity is typically blocked by scar tissue. Future assessment required specialized skills known as sonographically-guided hysteroscopic biopsy. This is often referred to reoperative hysteroscopic surgery (RHS). You can click here to learn more.

The purpose of this article is not to explain how these biopsies or treatments can be provided. However here are the “take-aways”.

Recommendations for Women Who have undergone any form of Endometrial Ablation or Endomyometrial Resection

  1. If you have undergone any form of endometrial ablation or resection procedure you should be seen annually.
  2. At the time of your annual you should report any change in bleeding patterns or inform your provider if you’re developing cyclic pelvic pain that is worsening or new.
  3. A transvaginal ultrasound examination should be a part of your annual visit. This allows the physician to establish a “baseline” of what your uterus looks like and makes it easier to diagnose subtle changes.
  4. If you are ever seen in an emergency room for abdominal or pelvic pain please remind your emergency room physician—who is often not a gynecologist– that you had an endometrial ablation or resection and to contact our office for further guidance.

 

The Center for Menstrual Disorders has a world-wide reputation in the recognition of and management of endometrial ablation failures. These recommendations do not reflect practice guidelines by any major professional organization such as the American College of Obstetrician and Gynecologists (ACOG) or the American Association of Gynecologic Laparoscopists (AAGL).   However, we have been managing these issues since 1989 and have published numerous articles on this subject in multiple peer-review journals.