New Option for Menstrual Bleeding

By Alynn Alexander, M.D.
Obstetrician/Gynecologist
Ocean Medical Center

Some women experience extremely heavy menstrual periods or bleeding between periods. In some cases, bleeding may be so severe and relentless that it interferes with a woman’s daily activities and can lead to chronic anemia or low blood count. This may result in fatigue more significant medical problems.

In general, bleeding is considered excessive when a woman soaks through enough sanitary products (sanitary napkins or tampons) to require changing every hour. Bleeding is considered prolonged when a woman experiences a menstrual period that lasts longer than seven days.

Heavy menstrual bleeding may first be treated with medications, such as hormonal contraceptives. There are also newer medication options that control the amount of bleeding from the uterine blood vessels. Some patients may continue to experience heavy menstrual bleeding despite medical treatment.

In the past, a hysterectomy (or removal of the uterus) was the only other treatment option, which is a major surgical procedure. But today, there is a less invasive procedure called endometrial ablation.

Endometrial ablation is a procedure to permanently alter a thin tissue layer of the lining of the uterus to stop or reduce excessive or abnormal bleeding. The lining of the uterus is called the endometrium, and is responsible for the monthly menstrual flow.

Endometrial ablation may be performed in a physician’s office, on an outpatient basis, or as part of a hospital stay. It is a short procedure that is done without any skin incisions and uses light anesthesia.

According to Alynn Alexander, M.D., an ob/gyn at Ocean Medical Center, “The uterine cavity is entered through the cervix and the uterine lining is destroyed using radiofrequency, heated fluid, a heated balloon, a freezing technique, or electrosurgery.”

She explains that after the procedure, minor side effects are common, such as menstrual cramping and nausea. Many patients experience a thin watery discharge, sometimes mixed with blood, for several weeks following the procedure. Most patients are able to return to typical levels of activity in 24 – 48 hours following the procedure.

“Up to 85% of patients will experience resolution of their heavy menstrual bleeding after undergoing endometrial ablation,” says Dr. Alexander. “Some patients may completely eliminate menstrual flow. While this is not dangerous, it is not the main goal of treatment.”

A few important facts to keep in mind if considering endometrial ablation:

A patient should undergo a complete gynecological exam prior to having an endometrial ablation. This may include additional procedures such as a pelvic ultrasound and endometrial biopsy (sampling of the uterine lining).

Endometrial ablation generally is not done in post-menopausal women.

Endometrial ablation is not recommended for women with certain medical conditions, such as disorders of the uterus where the endometrium is too thin, women with abnormal cells or cancer of the uterus, or women with current uterine infections.

Pregnancy is not recommended after an endometrial ablation, so it should not be used as a treatment option in women considering pregnancy.

Endometrial ablation is not a form of contraception. Protection against pregnancy should still be used in women of reproductive age after having the procedure.

A woman who has had an endometrial ablation still has her pelvic organs. Annual pap tests and pelvic exams are recommended.

Dr. Alexander advises, “Endometrial ablation is not for everyone, so it is important to talk to your doctor to see if it is right for you.