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
Continue reading “Life After An Endometrial Ablation”
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:
- 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.
- Women 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 hematometra. Learn more about hematometra.
- 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
- If you have undergone any form of endometrial ablation or resection procedure you should be seen annually.
- 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.
- 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.
- 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.
Well I can’t claim to have written the book on minimally invasive surgery but I have contributed many chapters over the years.
Yesterday I was happy to receive a copy of Minimally Invasive Gynecologic Surgery edited by a fine colleague of mine, Dr. Jon Einarsson, at Harvard Medical School. My own particular expertise is in hysteroscopy and hysteroscopic surgery. In this chapter I try and outline the latest in modern equipment used for these important techniques. Our hope at the Center for Menstrual Disorders is to educate the next generation of physicians in these important techniques—many of which were pioneered at our office.
Also, yesterday, our article entitled “See-and-Treat” Hysteroscopy in the Management of Endometrial Polyps” was published. I have written about this subject on our website. Many women suffer from endometrial polyps which can cause irregular menstrual bleeding, bleeding after intercourse and even post-menopausal bleeding. “See-and-Treat” Hysteroscopy is an efficient way to diagnose and manage these polyps in a single step.
See the entire list of our Articles & Publications
Uterine –or endometrial polyps (EPs)—are a common cause of abnormal bleeding as women age.
Endometrial polyps are a localized overgrowth of uterine lining (endometrial) tissue. They can look like small finger-like projections and vary from millimeters to centimeters in size. Some are covered with a delicate latticework of blood vessels, while others are not.
While they’re almost unheard of in women under 30 they can become a real nuisance as women get into their 30s, 40s and beyond. In some studies polyps are found in 40% of premenopausal women with menstrual disorders. Continue reading “What are Uterine (Endometrial) Polyps?”
The uterus contains two types of tissue. The inner lining, called the endometrium, is the tissue that sheds each month during menstruation. Most of the uterus, however, is composed of muscle tissue or myometrium. Both tissues are capable of producing benign “tumors.” Overgrowth of the endometrium causes uterine polyps while overgrowth of the myometrium causes myomas—commonly called fibroids. The name is somewhat misleading as the tissue is not fibrous—it’s simply muscle tissue that grows in the shape of a sphere.
Fibroids occur in almost 25% of all women in the United States and are responsible for over 200,000 hysterectomies annually. They can occur anywhere in the uterus and can vary in size from the size of a pea to a watermelon!
Continue reading “Fibroids: The Most Common Benign Tumor in Women”