Question:
Can we start out with a history of how the Woman's Diagnostic Cyber got started?
Dr. Rick:
Woman's Diagnostic Cyber started in October 1997. The web presented great opportunities to convey health information to women. Many
visits to physicians are basically to have questions and concerns answered rather than receive specific studies or treatments. The
web could certainly help provide some of those answers and reduce the need for doctor's visits. It would also enable women to have
much more input into their own decision making. It has certainly proven itself in that regard. I think we have barely scratched the
surface in improving health care for women by making the latest and best information immediately available.
Question:
There are several ways ablations are performed, i.e. balloon, rollerball, laser. Is any one way better than the other in terms of
success?
Dr. Rick:
Overall, thermal balloon seems to have more consistent results in the hands of different surgeons around the country. The technique
is quite standard and has minimal complications. The earlier techniques using an electircal resectoscope, laser or rollerball
sometimes were reported as having a higher, complete amenorrhea rate but there was also a greater variation in the success among
different surgeons. They also had higher complications because of burning deeper into the muscle tissue of the uterus. I would say
that if a surgeon were comfortable and experienced with a technique other than the thermal balloon ablation it is likely that they
have a good success with it and that technique is then a reasonable choice.
The complete amenorhea rate for thermal ablation is from about 25-35% and the failure rate to even improve heavy menstrual flow is
10-30%. The remaider of women have either light spotting, or light or normal menstrual flow.
Question:
After an ablation, because, we assume and hope, the uterine
lining is destroyed, does this make possible future uterine cancer harder to detect?
Dr. Rick:
Yes it can, in theory. As far as I know, however, this is more theoretical than actual. The truth is we have not been doing
ablations long enough to know whether the ablation will hide a newly developing cancer and if so, will it hide it for long so it
goes to an advanced stage before being discovered. My gut feeling is that this is not as much of a problem as we make it out to be,
but in this day and age of medicolegal ramifications we have to inform women that this is possbile.
Question:
Can women with polyps benefit from an ablation?
Dr. Rick:
Yes. This has been answered in women who are on tamoxifen for breast cancer treatment and get recurrent endometrial polyps.
Endometrial ablation significantly decreases the incidence of recurrent polyps from tamoxifen. It stands to reason that regular, non
tamoxifen associated polyps can also benefit from ablation.
Question:
Just how long will an endometrial ablation last? Does age have anything to do
with this the longevity of this?
Dr. Rick:
Again we do not know what the long term experience of ablation is because it has not had widespread use for very many years. So far
it looks as though the pattern of bleeding at two years out is the pattern that continues.
Two questions submitted from women that had an ablation:
Question:
I've had no bleeding at all in the seven months since my rollerball ablation. I'd like to know, is there a possibility the lining
could grow back to the point where there is light or heavy bleeding down the road? That's the downside to ablation vs.
hysterectomy -- the watching and waiting.
Dr. Rick:
You could still develop some light spotting or bleeding in the next 12-18 months but I would doubt very much it would go back to
either normal or heavy bleeding now that you've had 7 months of no bleeding.
Question:
If a woman has long, heavy periods (since age 12) for no known reason (diagnostic tests have revealed nothing that could be causing
this), and has had two ablations (one laser, one balloon), why would her periods not stop completely!?! Is it a matter of the
endometrial lining not being burned/damaged completely despite the two procedures? Or is it that the uterus heals very easily?
Dr. Rick:
It is most likely that the lining was not completely or deeply treated enough. It may be that the inside surface is more irregular
or just that the inside surface was not completely removed or cauterized with the procedures. We do not know of different capacities
to heal up but I suppose that could be possible.
Question:
As a physician, what is your own opinion on endometrial ablation as a hysterectomy alternative?
Dr. Rick:
It is an excellent option for women with very heavy and/or frequent menses who do not have fibroids or adenomyosis. It is optimally
suited for the woman who are at high risk for major surgery because of some risk factors or who is very much afraid of major surgery,
or who simply just does not want to have a hysterectomy.
Of the women I see who have treatment for menorrhagia with either hysterectomy or endometrial ablation, the ones having
hysterectomy are usually more pleased with the results because they made their choice because of other benefits of hysterectomy over
ablation such as no more bleeding at all, no more worry about endometrial or cervical cancer, no more cramps with bleeding, no more
pain with intercourse, less vaginal discharge, no concern of needing to take progestins with estrogen when they are past menopause
and just less visits in general for gynecologic problems.
Rick
Frederick R. Jelovsek M.D.
