Our Summary

Uterine leiomyomas, also known as fibroids, are the most common type of solid and symptomatic tumor in women. They are the top reason for hysterectomies (the surgical removal of the uterus). However, many women prefer other treatment options because they want to have children in the future or keep their uterus. This document gives updated recommendations based on scientific evidence for the medical, procedural, and surgical treatment of symptomatic leiomyomas. The use of morcellation, a procedure used in the surgical treatment of leiomyomas, isn’t covered in this document but is discussed in a separate publication by the American College of Obstetricians and Gynecologists.

FAQs

  1. What are uterine leiomyomas and how common are they in women?
  2. Are there alternative treatment options for leiomyomas other than hysterectomy?
  3. What is morcellation and how is it used in the treatment of leiomyomas?

Doctor’s Tip

One helpful tip a doctor might give a patient considering endometrial ablation is to discuss the potential risks and benefits of the procedure thoroughly. It’s important to understand that while endometrial ablation can be an effective treatment for heavy menstrual bleeding, it is not a permanent solution and may not be suitable for everyone. Patients should also be aware that pregnancy after endometrial ablation is not recommended and should use contraception to prevent pregnancy. Additionally, it’s important to follow post-procedure instructions carefully to ensure proper healing and minimize the risk of complications.

Suitable For

Endometrial ablation is typically recommended for patients who have heavy menstrual bleeding that has not responded to other treatments such as medication or hormone therapy. It is not recommended for women who still want to have children in the future, as it can make it more difficult to conceive.

Other conditions that may make a patient a good candidate for endometrial ablation include abnormal uterine bleeding, premenstrual syndrome (PMS), and adenomyosis (a condition where the inner lining of the uterus grows into the muscle wall of the uterus).

It is important for patients considering endometrial ablation to discuss their individual circumstances with their healthcare provider to determine if it is the right treatment option for them.

Timeline

Before endometrial ablation:

  1. Patient experiences symptoms of heavy menstrual bleeding, pelvic pain, and other menstrual irregularities due to uterine fibroids.
  2. Patient may have undergone diagnostic tests such as ultrasound or MRI to confirm the presence of fibroids.
  3. Patient may have tried conservative treatments such as medications or hormone therapy to manage symptoms.
  4. Patient and healthcare provider discuss treatment options, including endometrial ablation as a minimally invasive alternative to hysterectomy.

After endometrial ablation:

  1. Patient undergoes the endometrial ablation procedure, which aims to destroy the lining of the uterus to reduce or eliminate heavy menstrual bleeding.
  2. Recovery time is typically short, with most patients able to resume normal activities within a few days.
  3. Patient may experience some cramping, spotting, or discharge in the days following the procedure.
  4. Over the following weeks and months, patient should experience a reduction in menstrual bleeding and improvement in symptoms related to fibroids.
  5. Patient may have follow-up appointments with their healthcare provider to monitor their progress and address any concerns.

What to Ask Your Doctor

  1. What is endometrial ablation and how does it work?

  2. Am I a good candidate for endometrial ablation?

  3. What are the potential risks and complications associated with endometrial ablation?

  4. What are the expected outcomes of endometrial ablation in terms of reducing heavy menstrual bleeding?

  5. How long does the procedure take and what is the recovery time?

  6. Will I still be able to have children after undergoing endometrial ablation?

  7. Are there any long-term effects of endometrial ablation that I should be aware of?

  8. How often is endometrial ablation successful in reducing or eliminating heavy menstrual bleeding?

  9. Are there any alternative treatments for heavy menstrual bleeding that I should consider?

  10. How often will I need to follow up with you after the procedure?

Reference

Authors: [No authors listed] Journal: Obstet Gynecol. 2021 Jun 1;137(6):e100-e115. doi: 10.1097/AOG.0000000000004401. PMID: 34011888