Endometrial Ablation – a Personal Experience

Being female, most of us have problems with our reproductive system at some point during our lives. Most often these are normal of the natural aging process, however sometimes there can be the odd hiccup – and living in a world where such diseases as Cervical cancer are well documented and unfortunately common, it pays to be certain of your health.

My story began a couple of years after the birth of my daughter. It was a textbook pregnancy, and I had looked forward to the birth, telling myself that millions before me had done what comes natural. The birth was something else all together though – but that is another story!

I began to encounter what is termed as inter-menstrual bleeding, just a few sluggish spots each month, no pain, mostly just an annoyance. Months later it had become almost like having a second menstruation in the monthly cycle. I was anemic and constantly lacking in energy.

My doctor took a swab and a smear/pap test (come on girls – it’s a simple and painless procedure – check you modesty at the door!) and tested for common STD’s. Being happily married, I was mortified, but this is common practice and helps eliminate certain other causes, and when the Doctor explained this, I relaxed somewhat. Eventually everything checked out fine.

However, inter-menstrual bleeding usually indicates an irritation of the uterine lining.

I was then scheduled for a D & C (Dilation & Curette) where by the Specialist uses an instrument called a curette to remove the endometrium or lining of the uterus, which is usually performed under general anesthetic. In most cases the Specialist will also examine the uterus with a tiny telescopic instrument called a Hysteroscope.

A growth was removed and sent off for testing, hence the irritation to the lining. The tests proved the small mass to be a polyp, a type of tumor.

These are non-cancerous tumors that occur on the surface, and sometimes grow in the lining itself. They will continue to grow, and so it is advisable to have them removed. They can cause heavy bleeding, which can lead to a lack of iron in the blood, which then leads to fatigue. They are very common.

The operation was simple, and was performed as an Out-patient day surgery. Patients should not attempt any physically demanding work for at least two weeks after surgery, or until re-visiting the Specialist for clearance.

That was then…

Two years following, the bleeding returned. Another visit to the Specialist, more tests, and this time an internal Ultrasound was performed.

The Radiologist scanned the uterus and surrounding fallopian tubes and ovaries. Again, another mass was detected, and another operation was scheduled.

This time however, my Specialist advised of several approaches to finding a desirable outcome to suit my lifestyle.

As I had already had one polyp removed in less than 2 years, obviously having a D & C every couple of years is not desirable.

She suggested two procedures; another D & C, combined with the insertion of a special hormonal IUD, a contraceptive that would not need replacing for 5 years, but which would double as a deterrent for future polyp growth. This IUD does not release estrogen – which polyps respond to with excess growth.

The other suggestion was to have an Endometrial Ablation.

I must stress that when considering the options, do a thorough research, list out all the pros and cons for each procedure, and ask questions. Your Specialist should provide information packages for each operation, and please do read them!

Next our Specialist asks that tricky question: do we plan to have more children? In my case, I was quite happy with one child – it an easy decision.

Endometrial Ablation, in a nutshell, is the burning off of the endomentrium, the lining of the uterine wall. It is permanent and there is little chance of pregnancy after this procedure. However, because the operation cannot guarantee to remove the entire lining, there is still a very small chance of pregnancy, and so you must continue using some form of contraceptive in the years before and during menopause.

Do not be fooled into thinking it can be used as a form of permanent sterilization. There are many well-documented cases of ectopic pregnancies that have resulted (in some cases) in a full Hysterectomy – the removal of the uterus and ovaries. This throws the patient into full menopause. As we all know of the night sweats, mood swings and associated problems that come with middle age, we want to avoid menopause for as long as possible!

There are however, a few cases whereby a baby has been carried successfully to full term after this procedure, but the fact is the health and lives of both mother and fetus would always be at risk. It’s not worth it!

I was sent my pre-op package, showered off using the bacterial soap supplied, no food from the night before, and no water from about 4am. This is common, but depends on the scheduled time of individual operations.

I opted for the Menotreat system – a machine that the Specialist uses. It works by having a “bladder” inserted into the womb after the D&C, which is then blown up. Saline liquid heated to 85?C is then pumped inside to sear the lining. At no time does the liquid come into contact with any body tissue – it is circulated from the machine, into the menotreat bladder, and out again. The system has several safety checks so the system is very safe to use.

There are several different ways to burn off the lining, the best one at the moment uses a hand held laser to do the job. This gives the best outcome. However, this method is currently not yet available in my country.

The operation went smoothly (like a rack, pack and stack!) along with many other women during the course of the day, and I woke up in recovery, feeling quite drowsy.

I was to stay in ward for several hours observation, and once I felt well enough, I could go home.

Unfortunately for me, someone stuffed up my Meds! I had been warned the pain was quite high, but if they had kept to the protocol and not stuffed it up, I probably would not have suffered cramping so much. This would have been easily rectified if my buzzer had been working!

It was nasty! It was like having mild labour pains, but without break for about and hour. However, once the nerves began to die, the pain suddenly faded away.

True to Murphy’s Law, it was at about this time that the nurse checked on me and discovered the faulty buzzer.

I slept for 2 more hours, waking with an appetite.

After having a sandwich and a jug full of water, I felt well enough to go home.

I hardly bled at all, there was next to no cramping, and I felt quite good the next day – almost normal. It was the second day that I felt like someone had knocked my out with a brick.

I was okay, but just really tired.

On the forth day I was back at work.

Now, on mentioning the pain – yes, it was excruciating for a short while, but I must reiterate that had the nurses not mucked up my painkillers, I would have been fine. Having said that, the benefits of having the procedure done, far out weigh the nasty bits, not that there were many anyway.

I am happy to say I would recommend it to anyone with heavy bleeding and cramping, and those who are prone to polyp growth, especially if you have had all your children. For those women whom are perhaps in the younger age group, the Hormonal IUD would be a safer choice, if children figured largely in their future.

I feel that life is far more enjoyable, I can make plans without having to worry about what time of the month it is, and indeed I’m one of the luckier patients in that I no longer have any bleeding whatsoever. Most women who have had this procedure have little to no monthly bleeding, compared with previously suffering heavy and painful bleeding for most of their adult lives.

But beware… although after the operation you may have little to no bleeding, the cyclic bloating and urge for sweets unfortunately still occurs.

Well, you can’t have it all!