Routinely in my consultations, I get asked to explain some of the minimally invasive treatments for fibroids. Today I want to discuss Endometrial Ablation. This is a very common procedure often recommended by the gynecologist for patients with heavy bleeding. This technique basically destroys the lining of the uterus, known as the endometrial lining. It can be destroyed using various different techniques with either heat or cold. All ultimately do the same thing…..this procedure significantly reduces bleeding but if the ablation is incomplete…lining can regenerate over time and bleeding return. This is a treatment for heavy monthly periods, but not a direct treatment for fibroid tumors or adenomyosis.
We have rececently received many calls and emails about this disease. First let me say,we do NOT recommend hysterectomy for endometriosis. This is a disease that requires aggressive treatment, but removing the uterus is not one of them. Most patients get labelled with this diagnosis based solely on signs and symptoms ie: painful periods, cramping, bloating. Endometriosis is a microscopic condition…it does not show up on diagnostic testing like ultrasound, MRI or CTScan. Your doctor must be able to see the implants to confirm the presents of the disease. In order to confirm a diagnosis the patient will need surgery. If you think you might have this disease, contact your doctor for a consultation. Early diagnosis and treatment are critical with Endometriosis.
The complications associated with a hysterectomy, removal of the uterus, are multiple. Up to 75% of women have negative long term effects after this procedure. Most commonly seen are hormone imbalance (even when ovaries are saved), depression, bladder problems with either incomplete emptying of urine or incontinence, constipation and sexual dysfunction. Short of cancer, and sometimes uterine prolapse, we recommend saving the uterus. If you are having monthly problems……or have been diagnosed with a benign disease like fibroids or adenomyosis, treat the diseases but do NOT remove the uterus, especially as the first line of attack.
Recently we have received many emails regarding ovarian cysts.
If you have a diagnostic ultrasound and a clear fluid cyst is discovered, chances
are there is little to worry about. Women produce cysts monthly as part of
the regular menstrual cycle…the clear fluid cysts, known as functional cysts,
usually contain the egg that is released for conception. These cysts will rupture,
release the egg and often disappear. Of more concern are the cysts that appear septated, complex or blood filled. These require follow-up and may need surgery to be removed.
Many physicians currently advocate hysterectomy as the best form of treatment for
endometriosis. I disagree. Once endometrial cells have implanted within the pelvis,
removing the uterus has no effect on the current condition. Implants need to be destroyed to reduce pain and
cramping…..as long as the patient still has her ovaries, monthly flow of estrogen will fuel
the spread of the existing pelvic implants. Diagnosing and some treatment can be performed via a minimally invasive laparoscope that puts a camera in the abdomen near the belly button. This technique can be effective for treating early stages of Endo. Unfortunately, my practice often sees women with much more severe and advanced cases and the scope has too limited a field of view. An open surgery allows the entire abdomen and pelvis to be examined with laser treatment of all areas, not just those limited with the scope. The best course of treatment in advanced stages is an open surgery, not laparoscopy, with aggressive laser therapy.