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Endometrial Ablation



Hysteroscopy is a procedure that allows your gynecologist to visually examine the inside of the cervix (endocervix), the canal from the cervix to the inside of the uterus (endocervical canal), and the inside of the uterus (endometrial cavity).

Hysteroscopy was first described in the 1870’s, but has not been widely used by gynecologists until recently. Very small digital cameras combined with modern optics and “cold” light sources give the gynecologist a very detailed and accurate view of the inside of the uterus (womb). This ability allows a gynecologist who has training, skill, and experience with hysteroscopy to perform a number of procedures inside the uterus, many with the patient awake. Virtually all, however, are done as outpatient procedures, requiring little or no recovery time.

Two new hysteroscopic procedures will have a major impact on the lives of reproductive age women: hysteroscopic sterilization and endometrial ablation.

If you want no more children, your options have been limited to tubal ligation (by laparoscopy or laparotomy), hysterectomy, or long term use of birth control pills. Hysteroscopy offers an infinitely better option.

Sterilization by hysteroscopy involves no incisions, minimal or no anesthesia, and virtually no recovery time. Because there are no incisions, it eliminates the risks associated with tubal ligation. The procedure involves placement of extremely small devices into the opening of each fallopian tube as it enters the uterine cavity (the inside of the uterus).

Over the next three months, the fallopian tube simply grows into the device and occludes. An x-ray is done to confirm that the tubes are blocked (much like a semen analysis is done after vasectomy to make sure the procedure was successful).

For the woman with bothersome menses, new hysteroscopic endometrial ablation procedures offer her the opportunity to stop or minimize her menses without hormones or hysterectomy. Several techniques are used to coagulate the lining of the uterus, which is the source of menstrual bleeding.

All of these new techniques require minimal anesthesia, 1 ½ to 15 minutes of operating time, no incisions, and minimal to no recovery time. All completely stop menstrual bleeding in about 50% of patients and minimize bleeding in another 40%. Only 10% or fewer of patients will continue to have heavy periods after these procedures.

Soon, we will be able to perform both procedures in the same patient. Afterward she will be sterilized and having minimal or no menstrual periods. She will enjoy these benefits without taking hormones or undergoing any surgical procedures that require incisions. Her recovery is measured in hours rather than days or weeks.