May 6 , 2008
Treatment Options for Heavy Menstrual Bleeding
Joan Marie Pellegrini, MD
Many women experience heavy menstrual bleeding (otherwise known as dysfunction uterine bleeding DUB). DUB can become more common in our 40’s and 50’s. If you are one of these women, you may have been dealing with this problem for years. It can cause a woman to lose time at work and to lose confidence in being able to do certain activities. It can also lead to anemia. The first step that a women with DUB can do is talk to her doctor about it. There are many causes of DUB and cancerous conditions must be excluded. Once this is done, your doctor may try medication. If medications fail, there are several surgical options. Before considering any of these options, your doctor may have you undergo some tests such as a Pap exam, pelvic exam, and endovaginal ultrasound.
Up until approximately the early 1990’s, the only surgical option for DUB was hysterectomy which is major surgery. Even today in this country, many women undergo hysterectomy for this condition. Hysterectomy continues to be a viable option with excellent long-term results. However, there are now several less invasive surgical options for women with DUB. These procedures are collectively known as “endometrial ablation”. The endometrium is the lining of the uterus that sloughs monthly and causes the bleeding during menstruation. A surgeon can destroy this lining by using cryoablation (freezing), heat (thermoablation), electricity (cautery), microwaves, or laser. The most common procedure in this area is NovaSure which uses electrical energy. This procedure is usually done under general anesthesia and is an outpatient procedure. Another technique is cryoablation (HerOption) which has the benefit of being approved to be done in the office and therefore does not require general anesthesia.
Hysterectomy will lead to amenorrhea (no menstrual flow) 100% of the time. Endometrial ablation will lead to amenorrhea 30-50% of the time depending on the procedure, the surgeon’s technique, and the patient’s anatomy. Many women will also notice a decrease in their premenstrual symptoms (PMS). Endometrial ablation is safe but does have some rare risks which include perforation of the uterus, bleeding, and infection. This procedure can only be considered for women who are premenopausal and for whom child bearing is complete. Because the endometrium is destroyed, pregnancy becomes very unlikely but is not impossible. Therefore, these procedures are not considered a form of birth control.
For more information:
www.acog.org/publications/patient_education/bp134.cfm A site sponsored by the American College of Obstetricians and Gynecologists. This site has excellent information on endometrial ablation, its indications, risks, and outcomes.
www.NovaSure.com This site is sponsored by the company that markets this procedure. This procedure uses electrical energy to destroy the endometrium.
www.gynecare.com This site is sponsored by the company that markets ThermaChoice which uses thermal energy to destroy the endometrium
www.heroption.com This site is sponsored by the company that markets HerOption which is an office-based cryo-ablative procedure for destroying the endometrium.