Menstrual Disorders - Surgery

Hot Saline. Another recently approved technique (Hydro-Therm-Ablator (HTA) system) uses hot saline (salt water) to destroy the lining. It takes about 10 minutes to do this. This is not a "blind" procedure but uses hysteroscopy so that the surgeon can view the uterus.

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Laser Ablation. Endometrial laser intrauterine thermotherapy (ELITT) is an ablation technique that does not require either fluid or devices for expanding the uterus or direct contact with the endometrium. This appears to be a very effective approach.

Microwave Endometrial Ablation. Microwave endometrial ablation applies very low-power microwaves to the uterus, which limits tissue destruction only to the lining without causing any unnecessary harm to other tissues. It takes about three minutes. A 2002 study reported success rates equal to standard ablation and resection procedures.

Radiofrequency. An interesting investigative technique (Novacept RF Ablation Generator) employs an inflated device that uses radiofrequency to deliver power and evenly destroy uterine tissue. A suction device then removes moisture.

Specific Procedures for Women with Uterine Fibroids

Until recently, hysterectomy was the only surgical option for uterine fibroids. Other procedures, however, are now available:

Myomectomy. Myomectomy involves surgical removal only of one or more fibroids. It may be accomplished by performing a laparotomy (a procedure that uses a wide abdominal incision) or with less invasive surgical techniques such as laparoscopy and hysteroscopy. In such cases, unlike hysterectomy, fertility may be preserved.
Other Procedures. Endometrial ablation may be useful in women with small fibroids and heavy bleeding. More experimental procedures include myolysis and uterine artery embolism, which use unique techniques to shut off the blood supply to the fibroids.

Women should discuss each option with their physician. Deciding on the surgical procedure depends on the location, size, and number of fibroids and the experience of the physician. The risk for complications diminish with the surgeon's additional experience, so patients are urged to evaluate the surgeon's track record. [For detailed information, see In-Depth Report #73 Uterine Fibroids.]

Hysterectomy

Hysterectomy is the surgical removal of the uterus. About 600,000 hysterectomies are performed each year in the US, which is the highest rate among any nations with published data on this procedure. By age 60, about a third of American women have had this procedure. The highest hysterectomy rates are in women between ages 40 and 44. Women in the South and Midwest are more likely to have the operation than those in the Northeast and West.