Women may experience heavy menstrual bleeding (menorrhagia) for a variety of reasons, including normal hormonal changes prior to menopause or even uterine fibroids. When there is no clear explanation for bleeding, it may be classified generally as dysfunctional uterine bleeding.
Hydrothermal Ablation: Alternative to Hysterectomy
Certain types of medication can help to prevent or reduce uterine bleeding. But when medical management fails to provide adequate relief, endometrial ablation can be a hysterectomy alternative. During endometrial ablation, a thin layer of the inner lining of the uterus is burned away or ablated, using one of several methods.
According to Gynecologist Denise Harris-Proctor of The Group for Women in Virginia, an increasing number of gynecologists are performing this procedure using hydrothermal technology or heated water.
What to Expect During HTA
HTA can be performed in a hospital or surgery center and is often done under general anesthetic. However, some gynecologists, including Dr. Harris-Proctor, choose to have patients remain awake during this procedure, allowing them to make the doctor aware of any discomfort.
Prior to HTA, the patient receives preoperative anesthetic and oral and injected NSAIDS (non-steroidal anti-inflammatory medicine such as ibuprofen) for pain management. The patient is positioned as she would be for a typical gynecological exam and a paracervical block is administered to further block any discomfort.
After the cervix is dilated, the doctor introduces a hysteroscope, or intrauterine camera, for visualization during the procedure. Heated saline from the HTA machine is then flushed with gentle, controlled pressure throughout the inside of the uterus so that it touches all parts of the lining.
Not only can the doctor see the inside of the uterus to monitor for any problems during the procedure, explains Dr. Harris-Proctor, but the HTA technology also has the ability to detect any leaks, either in the machine itself or internally, and shut down automatically if one is detected to prevent injury. The procedure takes about ten minutes.
Advantages of Hydrothermal Ablation
HTA has several advantages over other types of endometrial ablation. A study conducted by the Department of Ob/Gyn at the University of Cologne, Germany and published on the NIH's PubMed website, suggests that the use of the hysteroscope for visualization during the procedure as well as the relative clinical simplicity of the procedure itself make it very safe.
In addition, Dr. Keith Isaacson, of Massachusetts General Hospital points out in the online journal OBG Management, that the amorphous nature of water helps ensure an even and thorough burn of the uterine lining, even in cases where an uneven surface, atypical shape or size, or large number of submucosal fibroids make that harder to achieve. Dr. Isaacson says the use of water increases the efficacy of the procedure and decreases the chance that the patient will need a hysterectomy - a much more invasive and traumatic procedure - to correct the bleeding problems.
Side Effects and Contraindications of HTA
Because it destroys the uterine lining, HTA is not recommended for women who may wish to become pregnant in the future. It is also not used for women with large uterine fibroids or for those who have cancer. An endometrial biopsy is often done prior to HTA to ensure that no cancer is present.
As with any invasive procedure, HTA carries a slight risk of infection and the rare possibility that the heated water can leak into the vagina or abdomen, causing burns.
After HTA, patients go home the same day and most can return to normal activities within a day or two. The German study found that about 85 percent of patients experienced significantly lighter bleeding or stopped having periods completely after hydrothermal ablation. The most common side effect is cramping.
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