What is Global Ablation?

Removal of the uterus lining (endometrium) to reduce heavy periods.

How Successful are Global Endometrial Ablation Procedures?

Ninety percent of women report long-term (at least five years) satisfaction with their ablation procedures.
In women 45 years or over greater than half will have no periods after an ablation procedure--the remainder will have significantly reduced bleeding. Women under 45 are more likely to continue to have periods but they are generally half to two-thirds lighter and shorter.
About 10-20% of women will continue to have heavy periods after an ablation procedure, depending on the original cause of their bleeding.

Advantages of Global Ablation Procedures

Safer than hysterectomy (complication rates 0.1% versus 5 to 10% for hysterectomy)
Does not affect hormone levels
Cheaper than hysterectomy
Less down time from work compared to hysterectomy (1 day versus 6 weeks)
Can be performed in the office with minimal anesthesia
Can be combined with other modalities (e.g. aromatase inhibitors) to optimize minimally invasive treatments for fibroids

Endometrial ablation and sustainable health care

From 2001 to 2007, after the introduction of global ablation procedures, hysterectomy rates in the state of California dropped 17%, making endometrial ablation an excellent example of sustainable health care.

Endometrial ablation done in the office with conscious sedation costs a few thousand dollars compared to hysterectomy which costs a range of $20,000 to $40,000 (hospital costs, supplies, anesthesia costs, surgeon fee).

Types of Ablation Procedures

Hydrothermablation

Water circulated at 90 degrees Centigrade for 10 minutes to remove the lining
Can treat submucus myomas (fibroids) up to 3-6 cm; irregular cavities, cavities larger than 10 cm
FDA approved 2001

Cryoablation

Freezes the uterus lining to minus 100 to minus 120 degrees Centigrade at tip
Requires 2 treatment cycles, 4-6 minutes each; requires little anesthesia
Can treat irregularities in cavity, 10 cm max depth
FDA approved 2001

Thermachoice Balloon Ablation

Central element heats liquid circulated in balloon
87 degrees C for 8 minutes
Limitations: uterine cavity size 6-10 cm; can't treat submucous myomas (fibroids just deep to the uterus lining)
FDA approved 1997, less commonly used than the other techniques described here.

Radiofrequency (electrocautery) Ablation

2 minutes once 50 ohms electrical impedance of tissue reached
Can treat normal size uterus
Can’t treat large uterus or irregularities (polyps, fibroids)

Microwave Ablation

Treatment temp 70 degrees C
Treatment time 6 minutes
10 cm cavity max
Can treat small irregularities (fibroids)
Available 2003

What’s Your Experience?

Have you had a global ablation procedure?
How satisfied were you with it?
What are the pros and cons for you?

Global Endometrial Ablation for Abnormal Bleeding: New Solution to Old Problem