What is cervical ablation and why is it performed?
Cervical ablation is a procedure that ablates (destroys) the inner lining of the uterus, the endometrium. The goal of this procedure is to reduce menstrual flow and it is performed in cases of AUB (Abnormal Uterine Bleeding). Endometrium is the inner lining of the uterus and it is replaced every month by hormonal changes provided there is no pregnancy established. By destroying the endometrium, your period will reduce or stop. Of course, this procedure can be performed only if is no pregnancies are planned.
In the past, the only solution to heavy and painful periods was a hysterectomy. Cervical ablation is a milder procedure and more importantly your uterus and ovary remain intact. By leaving your reproductive organs in place, you will be less likely to undergo menopause immediately. In fact, even if cervical ablation shouldn’t drive the menopause there are cases in which it happens and this can bring all the side effects that early menopause brings with it.
Research demonstrates that 10% of patients stop menstruating after cervical ablation, whilst 70% have lighter periods. It has also been demonstrated that your periods might come back, therefore the procedure is not recommended if you are many years away from the menopause. Moreover, there is absolutely no knowledge on the long-term effect and complication associated with cervical ablation. On top of that, a percentage of women undergo menopause after having had a cervical ablation. There is not enough literature to assess whether it can speed up the process, trigger it, or if it would have happened anyway.
There are different types of procedures for cervical ablation. The surgery is performed under general or loco-regional anaesthesia (spinal anaesthesia). The procedure can be performed in three ways, all by natural means:
The curettage. It involves scraping the inside of the uterus with a curette thereby “stripping” the mucosa. The fragments recovered are kept and sent for analysis. This is also the case when the procedure is carried out due to suspicion of cervical cancer.
Hysteroscopic Resection. This is the reference technique and the most used. A camera with a small hook at its tip is inserted into the uterus. The endometrium is resected shaving by shaving, and is then sent to the laboratory for analysis.
Endometrial thermocoagulation. This is the most recent technique, and its success rate is comparable to resection. A small plastic bag (balloon) is introduced into the uterus and filled with water, which will be gradually brought to very high temperatures. The heat diffuses through the plastic film and destroys the endometrium. For an analysis of the endometrium, a sampling is performed at the very beginning of the surgery by performing a small curettage.
After having had the ablation, sex and baths should be avoided for some time (this can vary depending on the type of cervical ablation and it is necessary to double check with your health provider). This is required for proper internal healing. A post-operative visit is carried out usually two weeks after the operation, during which analysis results are disclosed with the patient. Menstrual periods can be somewhat irregular during the 2 months after the operation but will be lighter than before or absent.
Hysteroscopic resection and thermocoagulation have a success rate of 70 to 80% in cases of heavy bleeding.
Radiofrequency. One of the most famous procedures includes Novasure. Novasure was approved by the FDA in 2001. It consists of different steps: first of all, a slender wand is inserted in the uterus and extends a triangular-shaped netted device. The netting expands, fitting to the size and shape of the uterus. Precisely measured radiofrequency energy is delivered through the netting for about 90 seconds. The netted device is then pulled back into the wand, and both are removed from the uterus. The procedure is pretty safe and effective.
Possible complications of endometrial ablation include:
- Tearing of the uterine wall or bowel
- Overloading of fluid into the bloodstream
- Premature menopause
Overall, cervical ablation is a valid procedure for women that want to reduce menstrual pain and heaviness of the period. It is necessary to be aware that periods may come back as heavy as before, therefore it is pivotal to perform the ablation closer to the average menopausal age. Moreover, the procedure can lead to premature menopause with all the risks associated with it. It is a simple and effective way to reduce AUB when compared to hysterectomy but there are still side effects to take into account.
Clinical practice guidelines on menorrhagia: management of abnormal uterine bleeding before menopause, H. Marret, Marret Fauconnier, N. Chabbert-Buffet, L. Cravello,F. Golfier, J. Gondry, A. Agostini, M. Bazot, S. Brailly-Tabard, J.-L. Brun, E. De Raucourt, A. Gervaise, A. Gompel, O. Graesslin, C. Huchon, J.-P. Lucot, G. Plu-Bureau, H. Roman, H. Fernandez. Curr Opin Obstet Gynecol. 2005 Aug;17(4):381-94. Endometrial ablation for heavy menstrual bleeding. Munro MG1.
Post-Ablation Tubal Sterilization Syndrome (PATSS) Following Novasure Endometrial Ablation: Two Case Reports and Review of Literature, T. Tam, C. Elgar, K. Jirschele, E. Lombard, Obstetrics and Gynecology, Resurrection Health Care/Saint Joseph Hospital, Chicago, Illinois