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Friday, 24 June 2011

Endometrial ablation as an alternative to hysterectomy for heavy periods

When endometrial ablation was introduced in the 1980's it was all the rage, and I was one of the few gynaecologists to start using this surgical treatment in Singapore for the treatment of heavy periods and fibroids in the endometrial cavity of the womb. Endometrial ablation involves in simple terms removing and ablating the lining of the the womb similar in the way an enlarged prostate is removed surgically in a man. It involves introducing an intrument through the cervix and stripping the lining of the endometrium and then with the aid of electrocautery ablating whatever remnant of the lining. It is a minimal invasive procedure with the patient going back the same day. For those patients who desired keeping their womb and were averse to surgical hysterectomy, this offered a good surgical alternative. However over the last 20 years of use, studies have shown that in about 20%, the heavy periods will recur as the endometrium has a tendency to grow back after several years. So most will go on to have repeated ablations and some end with hysterectomies. The types of ablation have evolved to include freezing, high thermal, and microwaving. Certainly endometrial ablation has a place in intractable menorrhagia (heavy periods) but not for everyone.

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