Endometrial Ablation
Novasure®, Thermachoice®, Hydrothermablation

Endometrial ablation is a procedure performed on the lining of the uterus in women who have heavy or prolonged periods.  Women who are finished with childbearing, but suffer from prolonged or heavy menses may elect to have endometrial ablation performed to reduce the severity of their bleeding.  There are many causes of heavy bleeding including fibroids, adenomyosis and uterine enlargement.  Hormonal factors may also play into heavier and prolonged bleeding. 

Patients will be assessed for signs of anemia and office procedures including ultrasound, hysteroscopy or endometrial biopsy may be performed to assure that there is no serious abnormality of the lining of the uterus such as cancer.  Many patients are candidates for endometrial ablation, thus avoiding the need for hysterectomy or more aggressive treatments.  Traditionally, endometrial ablation was performed in the operating room with the patient asleep using a hysteroscope.  The gold standard is using a loop electrode or ball to destroy the thin lining of the uterus called the endometrium or removing it.  Success rates show that 60% of women will completely stop having periods after having this procedure and up to 85% of patients will have significant reduction in their menstrual flow resulting in a very favorable assessment from the patient.  Over the past 10 years, numerous devices have been developed and are clinically available for use in the operating room.  These include Novasure®, Thermachoice®, hydrothermablation (HTA) and numerous others to perform endometrial ablation.  Success rates are only slightly lower than the traditional procedure performed through hysteroscopy.

In-Office Ablation

For the past decade, many of these newer devices have been successfully used for in-office ablations including Novasure®, Thermachoice® and hydrothermablation.   Minimal anesthesia is required including Motrin the night prior to the procedure and local anesthetic to the cervix at the time of the procedure.  The patients find the procedure very tolerable while awake.  Moving these procedures into the office provides the patient with numerous advantages including avoidance of general anesthesia, avoidance of the inconvenience of hospitals and operating rooms, the comfort of being in the doctor’s office which is a familiar setting for her and finally, significantly reduced costs of having these done in the office versus operating rooms.  Success rates are equal to those in the operating room and the patients are able to assume their normal activities immediately without the requirement of postoperative narcotics, disability, or recovery from anesthesia.  Of course some woman may choose to have this done in an operation room and this is easily accomplished.