Firsthand information about endometrial ablation

August 10, 2009 3:19 PM

Please tell me what you know about endometrial ablation as a means of lessening or hopefully stopping my bleeding. (This is a female-parts question.)

I'm looking for firsthand information on this procedure, if possible. I have only seen it mentioned a few times in a couple of threads from several years ago. I have Googled and gotten a pretty good idea of the mechanics of the procedure and how it's performed; what I'm looking for is personal experiences, info on whether I'd even be considered a candidate for it, that sort of thing.

I'm a single woman in my mid-thirties, live in the southern United States, casually sexually active, with no children and no desire for them, ever. I have had two abortions in the past. I only reveal this to really drive the point home that I do not want kids and will not be changing my mind.

Ever since I got my first period, my menstrual cycles were unpredictable, prolonged, heavy, and incredibly painful. When I was about 21, my doctor told me about Depo-Provera and I started using it (this was several years before the bone-loss issues were widely known). I was on Depo off and on for about ten years or so (got pregnant and had my second abortion during one of the "off" years). I absolutely loved the complete lack of bleeding while I was on Depo.

Unfortunately, last year I had a bone scan and was diagnosed with severe osteopenia (just shy of having actual osteoporosis), so my GYN insisted that I get off the Depo immediately and she put me on Sprintec birth control pills, to be taken continuously. I was aware that I probably wouldn't be completely bleed-free anymore, but I only expected occasional "spotting." After six months on the Sprintec (presumably the Depo had finally worn off) I started bleeding and didn't stop for a month and a half. Then I took a week off the pills (the "placebo" week, the way BC pills are normally taken, and on the recommendation of the GYN), stopped bleeding briefly, and then started bleeding again. Not monsoon-strength bleeding, but just enough to inconvenience me and constantly make me highly uncomfortable. I was pretty freaked out and expressed my concerns to the GYN, wondering if something might be wrong with me.

Without having me come in to see her, the GYN then switched my prescription to the lower-dose Lessina birth control pills, which I've been on for four months now. For the first three months there was just a little spotting, but now once again I'm bleeding constantly, with all the attendant discomforts (cramping, irritability, etc.) of a real period. I tried taking a week off, again, and the bleeding briefly stopped, but as soon as I got back on the pills I again started bleeding just enough to need tampons. To be clear, the bleeding is not what I think most people would consider "heavy," i.e., needing to change my tampon every hour, but it is constant (not stopping). I am taking the pills as directed, faithfully at at the same time every morning.

The last time I spoke to my GYN about all this, she told me dismissively that "every woman has to deal with some bleeding" and pretty much told me I should get over myself. I won't be going back to her. I'm not a moron and I don't want a doctor who only tells me what I want to hear, but I expect my doctors to be a little kinder when I'm freaking out about my body acting up.

When I find a new GYN, I will of course tell them everything and agree to any tests they might want to run. But I'd like to bring up the subject of endometrial ablation, which I didn't know about until recently and which I've been Googling and reading about, but I don't know anyone in real life who has undergone the procedure. Can any of you provide firsthand information? Will any doctor just refuse me outright if I ask about it? I am still relatively young and have no kids, and I keep reading stories about how doctors won't agree to sterilization procedures on younger people with no kids unless there's a serious enough medical condition to warrant it, and are always assuming a woman will inevitably change her mind later about wanting babies (about which, see above; I really won't).

I also have never been diagnosed with endometriosis, fibroids, cysts, or anything serious like that. My last few PAP tests have been completely normal, though I have not yet had one since going off the Depo last year. There is a history of breast cancer in my immediate family so I'm probably at a higher risk there. Would my current condition be considered "not bad enough" to justify a procedure like this?

Other things I've considered: The Mirena IUD, which was mentioned by my last GYN as an option (but not at the top of her list, since she said I need the estrogen in BC pills to help build my bones back up), but I really don't want to use an IUD. I have read up a lot on those, including many comments here on AskMe, and I know they're now considered very safe and effective, but for personal reasons that's not an option for me. I've also, in desperation, thought about begging to go back on the Depo and take some sort of calcium-building supplement at the same time, but I'm almost certain no doctor would agree to that, knowing what terrible shape my bones are already in.

I will follow up via the mods if necessary, but just to be clear, what I'm really looking for here is firsthand information about endometrial ablation, like, "I/my sister/my friend had the procedure and it was [a big help/a disaster/whatever]," or "I work at a GYN office and you [would/wouldn't] be considered a candidate because [whatever]. You would have to [ask nicely/get off the pills/bleed harder/have a baby/wait a year/whatever] before they would perform this on you."

I know that there is no guarantee it would completely stop my bleeding.

P.S., Any idea how much it would cost, assuming no insurance?

posted by anonymous to health & fitness (5 comments total)

My mother, who has had very heavy bleeding, pain, and irregular periods all her life, had this done a few years ago. As near as I recall, it helped some for a while. She was in her early 40s at the time, and I believe it helped get her flow down to a normal level. I'm not sure how long the effect lasted, but I do know that now she uses the NuvaRing and leaves one in continuously, just taking it out to have like four periods a year. She's happier with that method than with any other treatment she's ever had.

For what it's worth, my mom was never diagnosed with any specific gynecological issues, but I have endometriosis. Our symptoms have generally been very similar, so her GYN thinks there's a good chance she has endo as well. They've just decided not to bother doing the laparoscopy to get a real diagnosis at this point in her life.
posted by mostlymartha at 3:35 PM on August 10

Hmm. I had some pretty heavy bleeding for months after I went back on birth control continuously (Yasmin, in my case.) My endocrinologist, who also takes care of my GYN health, had me go off the Yasmin completely until I stopped bleeding, which ended up taking a couple of weeks. According to her, sometimes the uterine lining gets really thin and keeps building up and will just keep going until the hormones have stopped completely. (Or something. She's the doctor, not me. I just know it worked.) Now I take the pill continuously until I start spotting, have a week off, and get back on.

Would trying something like that be an option for you?
posted by sugarfish at 3:46 PM on August 10

I had the procedure done about two years ago and I'm very happy with the result. I can't tell you what it cost because I'm in Canada and it was done under our health care system so I didn't pay directly out of my pocket.

Some details: I'm now 50, have two kids, and my husband had a vasectomy after our second child was born. My situation is therefore a lot different from yours. However, about five years ago I had a problem with very thick uterine lining and developed very heavy bleeds. At the time it was put down to perimenopause and/or a side effect of the Tamoxifen I was on. Drugs are not an option for me because I'm a survivor of an estrogen-receptor positive breast cancer. My doctor took me off the Tamoxifen (I'd been on it for three years). I was still bleeding for months at a time, sometimes very heavily (yes, changing every hour). I became anemic.

I had a D&C done which helped with the bleeding for a little while. The problem resumed and so my OB/GYN recommended an endometrial ablation. I had the procedure done under a very light general anaesthetic but was home the same day. I took a couple of days off work because the cramps after the surgery were uncomfortable, but I was also indulging in some self-pity, too. Many women go back to work the next day. The bleeding from the procedure (I had to wear a pad rather than a tampon because of the risk of infection post-procedure) diminished and stopped after a couple of weeks.

Since then I've had no bleeding except for a period that came out of the blue after about 18 months. It was a normal period, 5 days and done, some cramps, some ibuprofen, nothing to write home about.

My OB/GYN said EA is not always successful, and often does not stop the bleeding entirely, but about 85% of women are very satisfied with the procedure. My family doctor said that having a good OB/GYN do the procedure is key. In my case, it appears to have worked a treat.

I have quite severe osteoporosis (at least for my age), am on Fosamax and am being assessed for suitability for Aclasta. Because of the previous cancer, estrogen therapy is not an option.

Hope this helps. Good luck!
posted by angiep at 3:59 PM on August 10

Am I a good candidate for EA?

EA is generally considered a treatment for "chronic, acute, excessive bleeding" that does not respond to other treatment. This may be you, but I am not clear from the question (since you indicate you don't have "heavy" bleeding).

To see if you are a viable candidate, I would recommend going to the EA discussion site , where in addition to useful FAQs about EA, there is a downloadable chart you can fill out that tracks just how much/how long you are bleeding. You can then take this to your next OB/GYN to help determine what to do about the situation.

It's likely a new OB/GYN might want to consider the *causes* more thoroughly before offering up a solution. One procedure for this a hysteroscopy (NOT A HYSTERECTOMY), where the same device that is used to look into the uterus during an EA is used to check for fibroids or endometriosis. I did read the question, and see that you have not been diagnosed with either, but diagnoses are rarely made in the absence of severe symptoms, which it appears you are now experiencing, and I would be concerned with your mention of previously very painful cramps, often associated with endometriosis. Endometrial ablasion is not recommended for endometriosis sufferers.
posted by misha at 6:01 PM on August 10

Don't know why the link didn't work out, here is the site I mentioned.
posted by misha at 6:02 PM on August 10