What Is Endometrial Hyperplasia? OR THICKENED ENDOMETRIUM?
Endometrial hyperplasia is an abnormality of the lining of your uterus or endometrium.
It is the major component of your monthly menstrual flow. It is completely normal for the lining of your uterus to get thicker or proliferate during the first half of your menstrual cycle.
But, if there is an imbalance in the hormonal stimulation of the endometrium an abnormality can occur. This abnormal change is an irregular thickening of the endometrium and is called endometrial hyperplasia.
WHAT IS HEAVY MENSTRUAL BLEEDING OR MENORRHAGIA?
Menorrhagia is menstrual bleeding that is heavy in amount or duration and that occurs at regular intervals. Loss of more than 80 mL of blood per menstrual cycle is considered abnormal.
Menorrhagia affects approximately 10-30% of premenopausal women and up to 50% of perimenopausal women.
Abnormal bleeding is a common reason for outpatient gynecologic visits and is one of the most common causes for surgery among women.
WHY A HYSTEROSCOPIC GUIDANCE ?
Hysteroscopy is a form of minimally invasive surgery. The surgeon inserts a tiny telescope (hysteroscope) through the cervix into the uterus. The hysteroscope allows the surgeon to visualize the inside of the uterine cavity on a video monitor. The uterine cavity is then inspected for any abnormality.
WHAT IS Endometrial ablation?
It is a procedure that destroys (ablates) the uterine lining, or endometrium. This procedure is used to treat abnormal uterine bleeding. Sometimes a lighted viewing instrument (hysteroscope) is used to see inside the uterus.
WHAT ARE THE TYPES OF Endometrial ablation ?
Laser beam .
Electricity, using a resectoscope with a loop or rolling ball electrode.
- A balloon filled with saline solution that has been heated to 85°C .
- Normal saline .
WHAT ARE The basic preoperative criteria for any patient opting for endometrial ablation?
Abnormal uterine bleeding of benign etiology (as evidenced by preoperative endometrial sampling and histologically benign findings).
No desire for future fertility.
Desire to retain the uterus or to avoid hysterectomy.
Although failure of medical therapy is not a prerequisite for the procedure, it is an important consideration.
WHAT ARE THE. contraindications for endometrial ablation ?
Pregnancy or a desire for future pregnancy.
Active urogenital or pelvic infection (eg, cystitis, vaginitis, cervicitis, endometritis, salpingitis, pelvic inflammatory disease [PID], or tubo-ovarian abscess [TOA])
Suspected or documented premalignant or malignant conditions of the endometrium or uterus.
Recent uterine infection.
A cavity that exceeds the device's functional length and uterine diameter.
History of a transmural myomectomy.
WHAT IS GEA?( GLOBAL ENDOMETRIAL ABLATION)?
GEA techniques have improved the ease with which gynecologic surgeons can effectively treat abnormal uterine bleeding of benign origin. Improvements in these devices have come quickly, including the ability to treat submucosal fibroids and irregularly shaped endometrial cavities. The high overall success and patient satisfaction rates reported with GEA techniques make them a viable option for conservative surgical management.
HOW DOES IT HELP?
The endometrium heals by scarring, which usually reduces or prevents uterine bleeding.
Endometrial ablation may be done in an outpatient facility . The procedure can take up to about 45 minutes. The procedure may be done using .general anesthesia.
What To Expect After Surgery?
After the procedure, you may have some minor side effects, such as cramping, nausea, and vaginal discharge that may be watery and mixed with blood. This discharge will become clear after a couple of days and can last for around 1 week.
It takes a 1-2DAYS to RECOVER. You can usually go home the same day .
How Well It Works?
Most women will have reduced menstrual flow following endometrial ablation. And up to half will stop having periods .
WHAT IS THE USE OF GnRH?
Young women may be treated with gonadotropin-releasing hormone analogues (GnRH-As) 1 to 3 months before the procedure. This will decrease their production of estrogen and help in thinning of endometrium.
HOW FAR IS IT SUCCESSFUL IN ACHIEVING PREGNANCY?
One often undetected cause of female infertility and recurrent miscarriage is a uterine septum. This uterine abnormality, present from birth, essentially divides the uterus in half, hindering a woman's chances for successful implantation of an embryo and carrying a baby to term.
What To Think About?
Regrowth of the endometrium may occur after you have endometrial ablation. This procedure is not recommended if you have a high risk for endometrial cancer.
Do not consider this procedure if you plan to become pregnant in the future.
WHAT ARE THE Outcomes?
Satisfaction rate with endometrial ablation is high. Compared with hysterectomy, endometrial ablation leads to fewer hospital stays and complications. In addition, it is more cost-effective than a hysterectomy, even when the need for repeat procedures or subsequent hysterectomy is factored in.
WHAT ARE THE Outcomes?
Although endometrial ablation prevents women from having children in the future, it cannot actually be relied on as contraception.
ANY NON SURGICAL METHOD FOR HEAVY BLEEDING?
Mirena - is a hormone releasing intra uterine contraceptive device.it is the only contraceptive approved to help manage excessive menstrual bleeding. Mirena is also the only non-surgical treatment option if you suffer from heavy periods.
How Does Mirena Lessen Heavy Bleeding?
The Mirena IUD is inserted into the uterus -- the progestin released by Mirena helps to reduce the thickening of the lining in your uterus (that happens each month). This makes the lining thinner, so there is less of it to shed off during a period... this equals less monthly bleeding.
HOW EFFECTIVE IS IT?
After 6 months of use, around 20% of women who use Mirena will not get a period at all. This number rises to about 50% after using Mirena for 5 years.
Any OTHER TREATMENT OPTIONS for heavy bleeding?
Medical therapy for menorrhagia should be tailored to the individual. Factors taken into consideration when selecting the appropriate medical treatment include the patient's age, coexisting medical diseases, family history, and desire for fertility. Medication cost and adverse effects are also considered because they may play a direct role in patient compliance.