Endomyometrial Resection (EMR)

I Know I Haven’t Written In Months…let’s Face It A Busy Practice And (can You Believe) A Three-year Old Son Will Throw Your Schedule Off A Bit. Time Has Accelerated A Good Deal With In The Past Few Years. In Today’s Article I Would Like To Discuss The Minimally Invasive Management Of Abnormal Uterine Bleeding—and Frankly How What Is Offered Here At The Center For Menstrual Disorders Is Unique And Superior– And Has Not Been Duplicated Anywhere Else In The World!

In November 1988—23 Years Ago– I Was The First Physician In Western New York To Perform Endometrial Ablation. Three Years Later, In 1991 Amy Daggett And I Invented Our Own Procedure—Endomyometrial Resection—which We Have Been Performing For 20 Years. In This Article I’ll Try To Explain What Endomyometrial Resection (EMR) Is And Why This Is The Most Successful Of All The Minimally Invasive Surgical Procedures For Treating Abnormal Uterine Bleeding In The World Today.

Endomyometrial Resection (EMR) – Invented Right Here In Rochester!

Endomyometrial Resection (EMR) (different than Endometrial Resection)Endomyometrial Resection (see right) is the systematic removal of uterine lining tissue—not the burning of tissue!

Amy Daggett, who’s been with me for 25 years, and I invented EMR in 1991. You may notice that there are a lot of procedures today known as endometrial ablation procedures. Perhaps you have a friend or relative who’s had one. After reading this article you’ll understand the superiority of EMR over these alternative procedures.

Here’s a little bit about the history of our procedure. Until 1988 women who suffered from heavy menstrual bleeding and who had completed their family had few options other than hysterectomy.

Believe it or not there was a time in the late 1970s when 750,000 hysterectomies were done in the U.S. each year and over 40% of women who died in the U.S. – a truly astonishing figure. You may have heard stories of women who had heavy periods, underwent a succession of “D and Cs”, perhaps were also treated with hormones – with its undesirable side effects—and ultimately, out of frustration, ended up having a hysterectomy. The technology at the time didn’t allow for other alternatives. So, if you couldn’t deal with the side effects of hormones, which included bloatedness and weight gain, you had two choices–either live with the problem or have a hysterectomy.

A hysterectomy in the 70s and 80s wasn’t a benign procedure. The recovery took from 3-6 weeks and sometimes more. Complications, including the need for blood transfusions and infection, were common and even after women “recovered” in 6 weeks it would usually take up to 3 months for them to regain the full level of energy that they had prior to surgery.

Then in 1988 a new technique called endometrial ablation became available. Endometrial ablation today includes several procedures but they all attempt to do the same thing—destroy the inside of the uterus (the lining that sheds each month) by heating it up or freezing it. These techniques are now being offered in many physicians’ offices.

Before you consider undergoing an endometrial ablation of any kind—NovaSure, Hydrothermal Ablation (HTA), Thermal Balloon (ThermaChoice) you should know the following:

  • They have a high failure rate! By 5 years about 25% of women treated with these methods will require a hysterectomy.
  • If they are done in a physician’s office—unless that office is an Accredited Office-Based Surgery Center these procedures can be very painful!

These procedures work very poorly if you have anything other than a “standard uterus”. This means that if you have any of the following you can expect even poorer results:

  • A uterus that is larger than ‘average’
  • A uterus that contains fibroids or polyps
  • If you are significantly younger than 40 years old.

We were the first to offer endometrial ablation in Western New York and made this available to our patients from 1988-91. We soon became aware of the shortcoming that I’ve listed above.

And so in 1991 we invented EMR and within 3-4 years we knew we had a superior procedure that is unmatched by any other “ablation” procedure available in the world today. Here’s why. Endomyometrial resection is the systematic REMOVAL not BURNING of uterine lining tissue. This provides the following benefits.

  • 1. You will not need a separate endometrial biopsy in the vast majority of cases—therefore one procedure can take the place of two procedures.
  • 2. The reason for this is that we remove tissue rather than destroy it and that tissue can be sent for analysis to be sure that you don’t have a precancerous or cancerous condition.
  • 3. Since the procedure is more predictable in terms of how much tissue is removed (destroyed) the number of women who are satisfied is far higher and the number of women who will eventually require a hysterectomy is far lower. Five years after an EMR fewer than 5% of women will require a hysterectomy – compared to 25% with ablation methods!

There’s a great deal of information on EMR later in this article and also on our website. So if you are considering a minimally invasive procedure (or know of someone else in a similar circumstance) for the treatment of abnormal or heavy menstrual bleeding learn the available alternatives.

Frequent Asked Questions (FAQs)

1. How many of these procedures have you done?

Between 1991- 2011 we have performed over 2,400 endomyometrial resection procedures. A third of these procedures also involve the removal of fibroids.

2. Can my doctor do an EMR?

I have personally trained 3 other physicians that are in practice in Western NY. You may wish to ask your gynecologist if he or she has experience with this procedure.

3. If this procedure is better than endometrial ablation, why don’t other doctors offer it?

EMR is a complex operation to perform and should only be done by physicians who are properly trained and have a sufficient number of cases that they perform regularly in order to maintain their skills. Just as you wouldn’t want you airline pilot to someone who flies on the occasional weekend off, you don’t want you gynecologist to do these procedures once in a while. In experienced hands, such as ours, complications are rare and success if very high.

4. My doctor wants to do an endometrial ablation (NovaSure, Hydrothermal Ablation, ThermaChoice Balloon) in the office. Will it hurt?

The short answer is “probably yes.” The real issue is that no one can predict whether or not your procedure will hurt—though in most cases it does. The issue is that if your procedure does cause significant pain what is your physician prepared to do about it? Will he or she be able to manage the pain or be forced to stop the procedure?

5. How do I know if my doctor’s office is “accredited” for office-based surgery?

I cannot overstate the importance of having your procedure done in an accredited office based surgery center. Please check out the following website. All offices that are accredited are listed on the New York State Department of Health website.

http://www.health.state.ny.us/professionals/office-based_surgery/practices/county/monroe.htm

6. How long have you been doing office-based EMRs?

We began offering office-based EMR in 2007 on selected patients. We have now done over 300 (as of this newsletter) office-based EMRs and we presently average four procedures per week.

 

Additional references to you should read before undergoing an office-based procedure.

http://www.health.ny.gov/press/releases/2009/2009-06-25_office_based_surgery_accreditation.htm
http://www.oprah.com/health/Questions-to-Ask-Before-Having-an-Office-Based-Surgery
http://www.health.ny.gov/professionals/office-based_surgery/practices/#county

Why Come To The Center For Menstrual Disorders?

Photo of the CMDRC, Rochester New YorkThe quick answer is this—because that’s what we specialize in! Gynecologists are typically the one’s that you might associate with caring for women with menstrual disorders—and for most women with menstrual disorders yours average gynecologist is quite adequate. However, if you’ve been told that you need one of the following procedures you should come and see us.

Also, if you’ve seen a gynecologist or a family physician and you feel that you’re not getting anywhere or that they’re not taking your concerns seriously enough you need to call us.

The Center for Menstrual Disorders was formed in 1986 in anticipation that new technologies would emerge that would replace hysterectomy as the main treatment for abnormal or heavy menstrual periods. That turned out to be true. There are many new methods of treating abnormal periods that were not available 25 years ago when we started. Many cases that once required hysterectomy can now be avoided altogether without surgery. Oftentimes, invasive surgical procedures can be replaced by simpler, less invasive office-based procedures. In many cases your physician doesn’t have the skills or the commitment to seek out a simpler answer. Here are some scenarios we see—all the time—where we have helped women avoided unnecessary or unnecessarily painful procedures.

  • “I had an endometrial ablation…it worked for a while and then I started having horrible periods again. My doctor told me I need a robotic hysterectomy.”
  • “My doctor told me that my uterus is the size of a 3 month pregnancy and that I should have a hysterectomy.”
  • “I’ve had abnormal periods for a year and my doctor wants me to have a D&C”
  • “My doctor wants me to have an endometrial biopsy…my friend had one and said it was the worst pain she’d had since childbirth. Isn’t there another answer? I don’t want to have pain.”
  • “I have horrible cramps with my periods…my doctor told me that I have endometriosis and that I should have a hysterectomy.”

The bottom line is that we see women like this every single day. All of them can be helped in one way or another. In many cases hysterectomy or painful office procedures can be avoided. Some women will require a hysterectomy—and if they do we will refer them to the most capable surgeons around. Almost all gynecologists know how to perform hysterectomies but, truthfully, not all gynecologists have superior skills.