Endometrial Ablation and Hysteroscopic Surgery

Over the past decade, a technique has been developed that can reduce or stop your periods without a hysterectomy. This surgery can be done in women who have flooding either with or without fibroid tumors. Dr. Dott was one of the surgeons who introduced this minimally invasive procedure in Atlanta. He has performed this procedure many times and is certified by the Accreditation Council for Gynecological Endoscopy in Advanced Hysteroscopic Surgery. He has taught this procedure in training institutions both in the United States and Russia.
 

This technique is called a hysteroscopic endometrial ablation or "roller ball surgery". Patients who have had this procedure have been followed for up to 10 years. During this period of time, they have enjoyed either complete, or almost complete, cessation of menses in over 90 percent of the cases. The "Roller ball" is done under general anesthesia or regional block (spinal or epidural). This is the outpatient procedure. Hospitalization is not necessary, except in rare instances. Following the procedure, patients note a brownish to slightly bloody discharge, which occurs shortly after the procedure, and last up to 6 weeks. Patients are advised to refrain from any kind of exercise for at least 3-4 weeks because there have been reports of heavy bleeding following strenuous exercises(i.e., moving furniture, cutting wood, jogging). Half the patients will experience no side effects with the cautery technique, and are back to normal activity within 2-3 days: the other half will notice a cramp-like sensation, and are tired for several days. Over 90 percent of the patients are back to normal activity within 4-5 days after surgery. Most patients take 4-5 days off work following their surgery, although some individuals have returned to work within 24 hours.
 

This operation may cause sterility, but it is not guaranteed. However, if you choose to be permanently sterile, a tubal ligation should be performed. Prior to using either cautery technique, it is important that the menstrual cycle be modified. This is achieved by taking tablets called danocine (Danazol) or medroxyprogesterone (Provera). Danocrine is a medication usually used for a condition called endometriosis. Generally, 2-4 pills a day are taken for 6 weeks. The side effects of Danocrine include weight gain, growth of hair, acne, and general malaise. The side effects of Provera include slight weight gain, depression, and PMS like symptoms. The third approach is an anti-hormone shot called Depo-Lupron. This medication causes a state of temporary menopause with hot flashes, vaginal dryness, and sleep disturbances. Because Depo-Lupron is quite costly ($500/month for 2 months), it is not used as often for preparation for this procedure. Following the cauterization of the uterine cavity, patients are often given an injection of a long-acting progesterone called medroxyprogesterone-depo (Depo-Provera). The shot will last approximately 3 months. During this time, a rare patient may experience mild depression. Bleeding is generally reduced when this medication is used post-operatively.
 

In virtually every case treated to date, there is either reduction or cessation of the menstrual flow. However, it takes 1 to 2 years to know exactly what the final results of the treatment will be. The complications of cauterization of the uterine lining include the risks of anesthesia and perforation of the uterus. A large volume of fluid is used during the procedure, and there is a rare chance of absorption of this fluid with mild alteration in blood products, i.e. electrolytes. The risk of perforation of the uterus is rare primarily because of the modifications that we now employ in performing the technique. Out of the first 100 women having this procedure, only 4 returned for a hysterectomy or more extensive gynecological surgery. 96% of the candidates were spared more extensive surgery.
 

This procedure has fewer surgical risks than a hysterectomy and provides an option to hysterectomy for stopping or reducing menstrual flow or for removing small fibroids or polyps while preserving a young woman's fertility. A new procedure called a Uterine Balloon Ablation was approved by the FDA in December, 1997. Both procedures are now offered by Dr. Dott.
 

Dr. Andrew Dott and The Institute of Endocrinology and Reproductive Medicine has set up a special program package (transportation, lodging, consultation, and surgery) for women who need this procedure and for whom it is not available in their community.