Endometrial Ablation for Heavy Periods in PeriMenopause
Heavy periods are a curse, and can dramatically affect our quality of life. I still cringe remembering walking out of middle school class backwards with a sweater tied around my waist hoping no one would notice the blood on my chair, and when this happens to you in your 40’s at work, it is definitely time to do something! If heavy periods are adversely affecting your life, for example by causing you to reschedule or avoid activities that you like, there are good options to consider apart from just waiting for menopause.
There are a couple of common reasons for heavy monthly menstrual bleeding. Especially towards the beginning and the end of our menstrual lives, hormone changes can cause the uterine lining to be excessively vascular and more prone to grow thicker each month. Thicker lining means there is more the shed, and while this can occur at any age, it is particularly common in teenagers and women in their late 30’s and 40’s. Another common reason is the development of benign muscular growths in the uterine wall called fibroids.
Fibroids occur in 40% of women and are usually asymptomatic, but they can also cause health issues including heavy bleeding and pain. Very rarely heavy menstrual bleeding is a sign of uterine cancer, but cancer is less likely to be cyclic (monthly) and is very uncommon in pre-menopausal women.
A pelvic ultrasound can determine if fibroids are present or not. If there are significant sized fibroids and they are symptomatic, generally we recommend surgical removal (either taking out the fibroids or the whole uterus depending on the patient’s age and reproductive desires). If a thick uterine lining is causing the problem, then several less invasive options are available. A couple of easy options that can thin the lining and reduce bleeding are birth control pills or the Mirena IUD.
But for many of us who do not need or want birth control, a more permanent solution to consider is an endometrial ablation. The medical term for our uterine lining that sheds every month is the “endometrium”. An endometrial ablation is an outpatient, no incision procedure that destroys the endometrium, permanently. There are several brand names of devices that have been designed for this purpose. All of them involve placing a device into the uterine cavity through the cervix (under anesthesia), then using an energy source to either burn or freeze the lining. If the procedure works well, once the lining has been destroyed it will never grow back, and patients experience either much lighter periods or no periods at all. The procedure takes less than 10 minutes (only 90 seconds for a Novasure) and patients can return to work and exercise the next day with minimal cramping.
We’ve have done hundreds of endometrial ablation procedures over the past 10 years and have had no significant complications, and a great success rate. Amongst our patients over 50% have no period at all and over 95% state that it has been at least a substantial improvement. I personally had a Novasure procedure (done by the fabulous Dr. Jurney) 12 years ago and have had no cycle of any sort ever since, which has truly been life-changing since I would bleed for 7 days and flood through a tampon in an hour! Some people are not good candidates for an endometrial ablation, including patients who desire pregnancy, patients with significant fibroids or patients with uterine cancer or precancerous conditions. (This is why we recommend that every patient considering an endometrial ablation have both an ultrasound and an in-office biopsy of the endometrium prior to the procedure, to make sure they are a good candidate).
While complications are very rare, there are some potential risks of any surgery that your doctor can go over with you if you are considering an ablation. If you have completed childbearing and are experiencing heavy menstrual bleeding, talk to your provider about your options, and definitely consider endometrial ablation. I am happy to share my personal Novasure experience with you if you would like to contact me!