Our Summary

This research paper is about abnormal bleeding from the uterus, a common problem in women. There are different causes for this, some linked to physical changes within the uterus (like growths or tumors) and others due to non-physical issues (like blood clotting problems or hormone imbalances). To find the cause, doctors usually do a detailed pelvic exam, blood tests, and sometimes a sample of the uterine lining, especially in older women or those with a history of exposure to high levels of estrogen.

If a physical problem is suspected, or if the symptoms don’t improve with initial treatment, an ultrasound of the uterus can be useful. There are various treatments available, both medical and surgical. For severe bleeding that causes instability in the body’s circulation, emergency treatments are available, including procedures to stop the bleeding, high-dose estrogen, and blocking the blood supply to the uterus.

However, if the patient is stable, doctors usually prefer to start with medical treatments to avoid the risks of surgery and preserve the possibility of having children. These treatments can include various types of hormones or drugs that help the blood to clot. The most effective long-term treatment for heavy periods is an intrauterine device that releases a hormone called levonorgestrel. Other options are similar hormones or drugs, and a type of surgery that removes the lining of the uterus.

The final treatment option is removing the uterus completely, but there are also less-risky surgical options available. Some patients with chronic bleeding can be treated with procedures to remove growths in the uterus or to block the blood supply to the uterus.

FAQs

  1. What is endometrial ablation and when is it used as a treatment option for abnormal uterine bleeding?
  2. What are the preferred initial treatments for patients with severe bleeding but who are hemodynamically stable?
  3. What is the most effective long-term medical treatment for heavy menstrual bleeding?

Doctor’s Tip

One helpful tip a doctor might tell a patient about endometrial ablation is to discuss the potential risks and benefits of the procedure, including the possibility of future pregnancy. Endometrial ablation is not recommended for women who wish to become pregnant in the future, as it can affect fertility. It is important for patients to have a thorough discussion with their healthcare provider about their reproductive goals before undergoing this procedure.

Suitable For

Patients who are typically recommended endometrial ablation are those who have abnormal uterine bleeding that is not responsive to medical management, have completed childbearing, and wish to avoid a hysterectomy. Endometrial ablation is often recommended for patients with heavy menstrual bleeding, irregular menstrual cycles, or bleeding in between periods. It may also be recommended for patients with conditions such as adenomyosis or fibroids that are causing abnormal uterine bleeding. Endometrial ablation is not typically recommended for patients who have certain conditions such as endometrial cancer, active pelvic inflammatory disease, or a desire for future fertility. It is important for patients to discuss their individual circumstances and goals with their healthcare provider to determine if endometrial ablation is the right treatment option for them.

Timeline

Before endometrial ablation:

  1. Patient experiences abnormal uterine bleeding
  2. Evaluation includes a detailed history, pelvic examination, and laboratory testing
  3. Endometrial sampling may be performed in certain cases
  4. Transvaginal ultrasonography may be recommended
  5. Medical and surgical treatment options are considered
  6. Emergency interventions may be necessary for severe bleeding causing hemodynamic instability

After endometrial ablation:

  1. Patient undergoes the procedure, which involves removing or destroying the endometrial lining of the uterus
  2. Recovery period may involve cramping, spotting, and discharge
  3. Follow-up appointments are scheduled to monitor progress and address any concerns
  4. Patient may experience decreased or no menstrual bleeding
  5. Long-term medical treatment options may be recommended to manage any remaining symptoms
  6. Hysterectomy may be considered as a definitive treatment option if necessary

What to Ask Your Doctor

  1. What is endometrial ablation and how does it work to treat abnormal uterine bleeding?
  2. Am I a candidate for endometrial ablation based on my medical history and current symptoms?
  3. What are the potential risks and side effects of endometrial ablation?
  4. What is the success rate of endometrial ablation in reducing or eliminating abnormal uterine bleeding?
  5. Are there any alternative treatment options to consider before proceeding with endometrial ablation?
  6. Will endometrial ablation affect my fertility or future ability to become pregnant?
  7. What is the recovery process like after undergoing endometrial ablation?
  8. How long can I expect the results of endometrial ablation to last?
  9. Are there any long-term complications or considerations to be aware of after undergoing endometrial ablation?
  10. What should I do if I experience any concerning symptoms or complications after undergoing endometrial ablation?

Reference

Authors: Wouk N, Helton M. Journal: Am Fam Physician. 2019 Apr 1;99(7):435-443. PMID: 30932448