Let’s Burn This Place Down: Uterine Ablations
A uterine ablation is a minor procedure to destroy the part of the endometrial lining that grows each month. The procedure is offered to women who have completed childbearing and who have heavy periods, but don’t have any mjor structural abnormalities or any cancer concerns. There are several different ways to do the procedure, but this post with focus on the novasure ablation device.
Many women find that when they reach their late 30s/early 40s their periods become heavier and crampier. There isn’t anything wrong per se, but things just get more uncomfortable and worse a little bit at at a time. This can be controlled using by a number of hormonal medications, but for women who are done with childbearing and ready to get off birth control and other hormones, a uterine ablation is an excellent choice.
The procedure is done by inserting a speculum and then directing a small camera into the uterus. Once we confirm the inside of the uterus is normal in size and shape, then we remove the camera and scrape out any lining that is present. We then insert the novasure device and make sure it’s touching all the corners of the cavity. Once it is, and the device completes its safety check, it will then perform a bipolar, radiofrequency ablation (read - burn it up to a crisp). We then check and make sure everything looks good and the procedure is complete. The entire procedure time is about 30 mintues and you get to take a nice nap during the procedure.
So, what can you expect afterward? You can expect minimal periods - about 92% of women have no bleeding at all, and this will probably last at least 5-7 years. If you are already in your 40s, this might get you all the way to menopause. If you are in your early 30s, it may not be permanent, but I’ve definitely had patients who made it from 35 to menopause. I’ve also had some who fit in the 5-7 year time frame. Most women who do continue to have a period afterward have minimal bleeding - usually just spotting, though, again, with time, this can return back to a normal period.
Is there anyone who can’t do an ablation ? Yes, if you are one of the tiny percentage of women who have a bicornuate or unicornuate uterus, this probably won’t be for you. Most arcuate uteruses are fine, but if you have a septum that’s essentially turning your pear shaped uterus into a heart shape, we may not get good results. If you have cancer - cervical or endometrial, this is a no go. You need a gyn oncologist and either surgery or chemo/radiation. If you have not completed childbearing, this is also not for you. The procedure essentially destroys the cavity, so plan on doing this after one member of the couple has taken one for the team and undergone permanent sterilization. Just saying, guys, your tubes are alot closer to the surface. For ladies, a tubal and an ablation can be done at the same time, but you will need to have the procedure at a hospital or surgery center.
Down time? You may have some strong menstrual type cramps for about 24-48 hours. Most people don’t require narcotic pain medication for this, and do well with 800 mg ibuprofen. You shouldn’t drive or sign legal documents for 24 hours after the procedure due to the potential sedating effects of anesthesia. No swimming for 2 weeks and nothing in the vagina for 2 weeks. You will likely have a watery discharge for 4-6 weeks afterwards. I also strongly advise husband’s that wives should avoid doing laundry for 4-6 weeks, but it’s up to you if you want to keep that recommendation!
Overall, this is a fantastic procedure to help with periods that are heavy, but without the 2 weeks off work for a hysterectomy and 6 weeks of lifting restrictions. We are excited at Advanced GYN to move people this procedure back into the office and out of the hospital setting. We can keep people comfortable and keep with the team they know and trust. If this is something you are concerned about, feel free to reach out and we will see what we can do to help.