Are Your Periods Crazy Heavy? This Treatment Could Make A Big Difference

The lowdown on endometrial ablation.

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endometrial ablation

Illustration, iStock.

From about age 14, Tracey Devine had always had terribly painful, heavy periods. They worsened after she became a mom, and by the time she was in her late thirties, “sometimes I was wearing two or three pads at once, and at certain times, to be honest, I used a baby diaper,” the Mississauga woman recalls. The embarrassment from the occasional accident was nearly as excruciating. “You think you have a pad on, and the next thing you know, you’ve bled through everything and onto someone’s couch.”

By 41, Devine was fed up. Birth control pills hadn’t lightened her periods at all, and having had her tubes tied, she wasn’t interested in trying a medicated IUD. “I went to my doctor and said, I can’t go on like this.” That left two possible solutions: a hysterectomy, or a less invasive procedure called uterine ablation.

What is an endometrial ablation?

Endometrial ablation is a procedure that permanently removes the lining of the uterus using some type of energy, such as heat, cold, or electricity. (Removing this lining greatly reduces the chance of future conception.) There are two different types, says Dr. Nicholas Leyland, chair and chief of the department of obstetrics and gynecology at McMaster University in Hamilton, Ont. Resectoscopic ablations are done in the operating room (typically under general or spinal anaesthesia) using a lighted instrument to see inside the uterus, and a combination cutting/cauterizing device. The non-resectoscopic method doesn’t require direct visualization (instead employing, for instance, tools like a balloon filled with heated fluid) and uses local anaesthetic and sedating medication.

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NovaSure, the non-resectoscopic technique used at McMaster, delivers bursts of radio-frequency electricity via mesh, and typically takes less than ten minutes. A hysterectomy involves a minimum two-week recovery time, but with ablation, “most patients are back to normal function within a day or so,” says Leyland. (Some possible side-effects include nausea and cramping, which typically pass within a few days, and vaginal discharge, which can last a week or two.)

Who is a good candidate for endometrial ablation?

Abnormally heavy periods that are seriously affecting your life make you a candidate for ablation. You should also be finished having children but still willing to use some form of birth control, since pregnancy following ablation is uncommon, but dangerous. A work-up prior to the procedure is standard, including imaging such as transvaginal ultrasound, and a biopsy of the uterine lining, to rule out other causes of bleeding (such as cancer), and to ensure your uterus and uterine cavity are normal. In the case of non-resectoscopic ablation, “patients need to be accepting of a procedure under local anaesthesia,” Leyland says, which may rule out those with a low pain threshold.

And while ablation carries a lower risk of complications than hysterectomy, there is the slight possibility of problems such as uterine perforation, infection, or hemorrhage. (The odds of such serious complications vary from a low of 0.3 percent — the rate of perforation for non-resectoscopic ablations — to 3 percent — the rate of hemorrhage for the resectoscopic type — which is considered safe overall.)

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“Even with the best technology, less than 50 percent of people will stop bleeding [completely],” notes Leyland, “although a large percentage will have much shorter, lighter periods.” That means while the vast majority of women will be satisfied with the results one year following the procedure, some will ultimately go on to have a second ablation or a hysterectomy. (According to a 2009 review of 25 randomized trials, between 88 and 91 percent of women are content with the outcome, and roughly one in four end up having a second procedure within five years.) “Generally, women who are closer to menopause are much better candidates, because the success rates are much higher,” Leyland explains. “If you do it below age 35, the likelihood of recurrence of bleeding is certainly higher.”

What else do I need to know?

If you’re curious about the procedure, raise it with your family physician and ask to be referred to a gynecologist to discuss it.

Not all hospitals offer ablations, nor are all gynecologists trained in doing them, so you may have to do a bit of detective work and possibly even travel to get one. And since your odds of complications hinge on how frequently your care provider does the procedure, you might want to do a bit of research beforehand, too. “We tell patients it’s important to ask questions like how familiar are you with this, how many do you do, and what are your complication rates,” Leyland stresses.

In the six years since her ablation, Tracey Devine has been symptom-free, apart from the odd mild cramp and spot of pink, and she couldn’t be happier. For her, it was “life-changing,” she says.