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Dan C. Martin, MD
UT Medical Group,
Inc.
University of Tennessee Health Science Center (UTHSC)
UTHSC Academic Office
Daniel Clyde Martin, M.D.
UT Medical Group,
Inc.
Infertility and Gynecology
Reproductive Surgery
Germantown Office Building
7945 Wolf River Boulevard
Suite 320
Germantown, Tennessee
TN 38138-1733
(901) 347-8331
(901) 347-8188 fax
Directions to Office
Updated information is
at
UTMG 2006
Click for information
on:
Glenn Ann Martin, Ph.D.
Clinical
Psychologist
| |
ENDOMETRIAL ABLATION
Goldrath reported endometrial ablation using a Nd:YAG laser in 1981.
DeCherney simplified the procedure using an electrosurgical resectoscope in
1987. Electrosurgical rollerball ablation was covered in the Ladies Home
Journal in 1989. More recently water heated balloons, electrical fans,
freezing devices, laser thermal ablators and other techniques have been
marketed. Although the balloon and other devices have their own champions
with a normal size uterus, the most
important factor appears to be the training and experience of the physician
performing the procedure. A combination of electrosurgical resectoscope
and rollerball appear more useful than balloons when there are fibroids or an
enlarged uterus.
Short term results are usually good in 90%
of women. 40% of these have no bleeding, 40% have spotting and 10% have
light periods. The other 10% continue to have problems with bleeding and
need a hysterectomy.
However there is a slow
increase in bleeding over two to ten years. Many women are back to their earlier bleeding
pattern and undergo a second ablation or a hysterectomy. These long term results suggest that this procedure
is best for women in their forties. These women will often go through
menopause before bleeding returns. On the other hand, women in their
thirties will usually need repeat treatment in ten or more years.
One significant concern is that scarring
can trap smaller areas of endometrium where
they cannot be sampled. If cancer developed in these smaller areas in the
future, diagnosis might be delayed and advanced stages of cancer could occur
before symptoms developed. The risk of this is diminished since endometrial
ablation removes the majority of the cell population at risk for the development
of endometrial cancer. However hormonal therapy may require addition of
progestins due to this possibility.
Another concern is pregnancy after
ablation. Most pregnancies miscarry. Complications of ongoing pregnancy are expected to
be high due to the decreased
lining area. Tubal sterilization can be done at the same time as ablation
to decrease this possibility.
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 | Goldrath M, Fuller T, Segal S. Laser photovaporization of the endometrium
for the treatment of menorrhagia. Am J Obstet Gynecol 1981; 140:14. |
| DeCherney AH, Diamond MP, Levy G, Polan ML. Endometrial ablation for
intractable uterine bleeding: Hysteroscopic resection. Obstet Gynecol
70:668-70, 1987. |
| Battelle P. Raquel Welsh starting over. Ladies Home Journal, May:46-59,
1989. |
| Goldberg JM.
Intrauterine pregnancy following endometrial ablation.
Obstet Gynecol 1994 May;83(5 Pt 2):836-7 |
| Pugh CP, Crane JM, Hogan TG.
Successful intrauterine pregnancy after endometrial
ablation. J Am Assoc Gynecol Laparosc 2000 Aug;7(3):391-4 |
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page.
Dr.
Dan Martin's office
for infertility, fertility
preservation, reproductive surgery and
gynecology is located at 7945 Wolf River Boulevard, Suite 320, Germantown, TN
38138. Memphis, Tennessee is convenient to
Arkansas (AR), Mississippi (MS), Missouri (MO), western Kentucky (KY), and
southern Illinois (IL).
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