Making an Informed Decision about endometrial ablation and the questions you must ask your physican BEFORE YOU UNDERGO ENDOMETRIAL ABLATION!

Posted on June 5, 2019

First, a disclaimer. I don’t perform endometrial ablation (EA) anymore. But, I was the first physician in Western New York to perform it 30 years ago in 1988. In 1991 our team invented a procedure called Endomyometrial Resection or “EMR”. Since then we, at the Center for Menstrual Disorders, have performed some 3500 operative procedures for managing abnormal menstrual bleeding.

To my knowledge we are the only facility in the United States that manages the common complications of endometrial ablation known as LOEAF or late-onset endometrial ablation failure. LOEAFs often present months or years after an ablation with women complaining of pain, irregular or heavy periods, or both.

As you might imagine we get many calls and take care of many out-of-town “guests”. Many of the cases are heartbreaking as women often report severe pain, very inconvenient and untimely emergency room visits, inconclusive testing, unnecessary operative procedures and more. Especially vulnerable are women with pain who often feel worse off than prior to their procedure.

In 99% of cases the treatments fall into 3 categories which include (i) “live with it”, (ii) oral contraceptives, or (iii) hysterectomy. At our office we are able to treat many, but not all, of these failures and, in well-selected patients, we have been quite successful in averting a hysterectomy.

But that is NOT why I’m writing this article.

I realize that most women are not going to travel to Rochester for their care. But I implore you that before you undergo an endometrial ablation, of any type, please ask your doctor the following questions?

  1. What are my options besides an endometrial ablation?
  2. Do I have any evidence of a uterine fibroid within the uterine cavity (submucous myoma)? And if I do, will you remove it before performing the endometrial ablation.
  3. What is the likelihood that someone MY AGE I will make it to menopause without a hysterectomy?
  4. If my endometrial ablation fails how will I know it? Will it be obvious or will it mask as something else?
  5. If my endometrial ablation fails how might you treat me?

This is by no means a complete list of questions you’ll need to ask your doctor. But keep in mind that 25% of women who undergo endometrial ablation in the United States will ask to have a hysterectomy within a period of 5 years. The SINGLE MOST IMPORTANT RISK FACTOR FOR FAILURE IS AGE! Women under the age of 35 are the most likely to experience an endometrial ablation failure, while women over the age of 45 are least likely.

If you are inclined, please visit our website and the following links to learn more about the prevention and management of endometrial ablation failure.

If you would like to learn more about why we invented endomyometrial resection (EMR) click below:

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