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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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bulletGoldrath M, Fuller T, Segal S. Laser photovaporization of the endometrium for the treatment of menorrhagia. Am J Obstet Gynecol 1981; 140:14.
bulletDeCherney AH, Diamond MP, Levy G, Polan ML.  Endometrial ablation for intractable uterine bleeding: Hysteroscopic resection. Obstet Gynecol 70:668-70, 1987.
bulletBattelle P.  Raquel Welsh starting over.  Ladies Home Journal, May:46-59, 1989.
bulletGoldberg JM. Intrauterine pregnancy following endometrial ablation. Obstet Gynecol 1994 May;83(5 Pt 2):836-7
bulletPugh 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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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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