New Surgical Options for Heavy Menstrual Bleeding

Endometrial Ablation Offers Freedom from Pain and Anxiety

Women's uterine health problems often remain a mystery to them while their doctors grapple with treatment options. Too often, patients' choices may seem limited and doctors may be unaware of alternative methods. However, innovative practices are now creating safe and effective alternatives to hysterectomy.

One in five women across the country suffers from a condition few have heard about: heavy and prolonged periods, known as menorrhagia. Women who have this condition are often forced to restrict day-to-day activities and many cannot leave their homes for days because their blood loss makes them extremely tired, they experience painful cramping or for fear of potential embarrassment. Other women feel their job performance is diminished due to anxiety and frequent restroom breaks. In addition, many women schedule vacations around their periods, and if the condition is present, plans are often ruined or cancelled. Approximately 10 million women in the U.S. suffer from menorrhagia.

While the clinical definition of menorrhagia is a loss of 80 milliliters of blood per cycle, it is not necessary to measure blood loss to determine if a woman is suffering. Many women suffering from menorrhagia fail to recognize their symptoms may be a result of this treatable condition, and others may be too embarrassed to address the subject with their physician. Some still view their prolonged and heavy bleeding as an inconvenience rather than a health risk. In the past, women suffering from menorrhagia were typically offered treatments ranging from drug therapy to hysterectomy. However, for many women, these treatments may be ineffective or unnecessarily invasive.

Hormone therapy, oral contraceptives or hormones to control a woman's hormonal balance are commonly used as the first option in the treatment of excessive menstrual bleeding. The drugs may reduce, but generally do not eliminate, excessive bleeding. Most concerning is this therapy is only effective 50 percent of the time and can be associated with undesirable side effects, including headaches, weight gain, and nausea. Hysterectomy remains the most common treatment for excessive menstrual bleeding because it guarantees complete cessation of bleeding, also called menorrhea. Six hundred thousand hysterectomies are performed each year in the United States and more than one third are performed to alleviate excessive menstrual bleeding.

Hysterectomy - a complete removal of the uterus, and in half of all cases, removal of the ovaries as well - is a highly invasive procedure that requires hours of operating time and general anesthesia, which creates the risk of complications and a long recovery period. About 200,000 annual hysterectomies are performed to alleviate menorrhagia, meaning that four potentially unnecessary hysterectomies occur every 10 minutes in the U.S. While this type of surgery is an effective treatment option that may be best for some women suffering from various gynecological issues, it may be unnecessary for many since women suffering from menorrhagia due to benign causes may now choose less invasive options.

A form of endometrial ablation known as NovaSure is a safe, effective and fast alternative for women who do not intend to have any more children and no longer want to suffer from the debilitating symptoms of excessive menstrual bleeding. The procedure has changed the lives of many women by reducing or eliminating their periods. NovaSure uses precisely measured radio frequency energy delivered via a handheld tube to destroy the uterine lining. The minimally invasive treatment takes approximately 90 seconds, can be performed in an outpatient setting, and requires no hormonal or surgical pre-treatment. Most patients are able to return to their normal activities the following day. In a recent five-year clinical study measuring the safety and efficacy of NovaSure, 97 percent of patients reported a reduction in bleeding to normal levels or less and more than two-thirds reported that their bleeding had stopped completely. Patients also stated that the procedure has improved their overall quality of life.

In addition to NovaSure, there are other alternative methods to hysterectomy, including:

• Dilation & Curettage (D&C), a technique that involves dilation of the cervix and curettage, or scraping of the inside of the uterus. Although D&C requires minimal recovery time, it is only effective for fifteen percent of women seeking a reduction in bleeding. The solution is most often temporary, reducing bleeding for just a few cycles before excessive menstrual bleeding returns.
• Conventional Endometrial Ablation, a technique known as hysteroscopic Rollerball Endometrial Ablation (REA), and commonly referred to as "rollerball" ablation, uses a heated roller ball to destroy the inner lining of the uterus and requires the administration of general anesthesia. Less than fifteen percent of gynecologists in the United States are trained to offer this procedure.
• Global Endometrial Ablation is a new generation of endometrial ablation devices, including NovaSure, gaining popularity because they are minimally invasive, can be performed on an outpatient basis, have rapid treatment times and require short recovery periods. Endometrial laser ablation uses laser equipment and an optical fiber delivery system to deliver energy that warms and eventually destroys the endometrial tissue.
• Uterine balloon therapy uses a balloon catheter filled with heated solution that is inserted into the endometrial cavity, inflated and then heated to destroy the endometrial lining.
• Other techniques use microwave energy or freezing temperatures to destroy the uterine tissue.

Women often have high pain thresholds, and in many cases, severe symptoms that occur during their periods tend not to raise alarms. But the consequences of ignoring them can be serious. In addition to the health consequences of heavy and prolonged periods, many of the symptoms associated with menorrhagia mentally, physically and socially affect a woman's quality of life.

I encourage women who have extreme periods that affect their daily life and prevent them from doing the things they love, to make an appointment to talk with me about appropriate options for them. Excessive menstrual bleeding is no longer a condition women need to endure now that simple and effective solutions have been shown to improve sufferers' quality of life.

William Jamieson, MD is Board Certified by the American Board of Obstetrics & Gynecology and practices at Christ Hospital and University of Cincinnati College of Medicine in Cincinnati, Ohio. For more information about menorrhagia or current treatment options, please contact Dr. Jamieson at (513) 241-7744.