There are many changes that can occur in a woman's body during the course of her life that may result in heavy bleeding or pain.
Endometrial ablation is the surgical destruction of the lining tissues of the uterus, known as the endometrium. Endometrial ablation is a treatment for abnormal bleeding of the uterus that is due to a benign (non-cancerous) condition.
Lawrence Koning, MD is here to explain that endometrial ablation is a special treatment designed to reduce menstrual bleeding or, in some cases, eliminate it entirely.
Selected Podcast
Do You Suffer from Pelvic Pain?
Featured Speaker:
Lawrence Koning, MD
Dr. Koning specializes in Obstetrics & Gynecology and is a member of the medical staff at Corona Regional Medical Center. Transcription:
Do You Suffer from Pelvic Pain?
Melanie Cole (Host): There are many changes that can occur in a woman's body during the course of her life that may result in heavy bleeding or pelvic pain. My guest today is Dr. Lawrence Koning. He specializes in obstetrics and gynecology and is a member of the medical staff at Corona Regional medical Center. Welcome to the show, Dr. Koning. What are some reasons a woman might have pelvic pain or heavy bleeding?
Dr. Lawrence Koning (Guest): Well, there are a lot of reasons women have pelvic pain. More commonly, though, is that they have heavy bleeding. Most women do, to be honest, hate their periods, so there are a number of ways to treat that, but pelvic pain can be caused from endometriosis; it could be caused from tumors such as fibroids, or just basically heavy periods, which is very common.
Melanie: So, how would we know that this pelvic pain--when do we go see a doctor if we are suffering, because, sometimes hormone levels or things can cause pain in the pelvis.
Dr. Koning: Well, almost all women will occasionally have a heavy period or pelvic pain and cramping with their period, but if they start having increasing pain, or certainly if their periods are longer than usual--more than four to five to seven days--and they're having clotting and changing their feminine hygiene more than every one or two hours, certainly that's the time to go see the gynecologist.
Melanie: What would be the first line of defense if a woman did come to you and say she has pelvic pain or heavy bleeding?
Dr. Koning: Well, the most important thing is to get a complete history and physical. Of course, it depends on the woman's age and what her childbearing desires are--if she's already had kids or wants more kids, those are certainly important things depending on what all of her symptoms are. If they have pelvic pain and they're very young, they can usually--of course, they need an ultrasound, a physical exam, more of a history to determine how long the pain has been going on, if it's related to various things and activities they're doing, such as sexual intercourse or other activities. Or, if it's just mild pain and cramping with their periods, then that can be much less serious, but certainly the first step is to get an appointment with some gynecologist they trust and have an exam and have a history and have some imaging, such as ultrasound, which is very safe, and then go from there and determine what the next choices would be.
Melanie: So, tell us about one of those choices: endometrial ablation. What is that?
Dr. Koning: Well, endometrial ablation is one of my personal favorites because it is so safe and simple. It's a very quick outpatient procedure. The actual procedure takes about 10 minutes and I almost like to liken it to a microwave. It sounds maybe a little unusual to a woman the first time, but rather than having a hysterectomy and, quite honestly, many women don't want to even to go to the gynecologist because they're afraid they'll get rushed to a hysterectomy. I've found if you sit with them and explain how simple the ablation is--it's a very simple outpatient procedure that takes about ten minutes, and it is very effective, and so it's one of our favorites to stop heavy bleeding. They do have to be finished with their childbearing, so it depends on their situation, age and how many kids they have, but it is a very effective procedure.
Melanie: And, if somebody is a candidate for endometrial ablation, what's the procedure like?
Dr. Koning: Oh, it's very simple now. Sometimes we are able to do those in the office but, typically, we'll do those in the hospital. It's a little bit safer that way with the anesthesiologist present. There is light anesthesia where they're sedated, and then they have local anesthesia around the cervix, but the actual procedure is about 8-10 minutes where we take a look inside with a camera inside the uterus and then a device called a “Novasure Endometrial Ablation Device” is placed in there for about typically a minute to a minute-and-a-half and that basically cauterizes the inside lining of the uterus which may sound a little unusual, but it actually very, very safe and the results are very remarkable.
Melanie: What is it like for a woman afterward?
Dr. Koning: There's very little cramping afterwards, maybe for a couple hours, and we give them some pain pills, typically. They can go home just within an hour or two after the procedure and then they may have some little drainage or discharge for up to a week or two, sometimes slight drainage for longer than that, but typically it's sometimes just for a few days.
Melanie: You mentioned when you were speaking about candidates for this procedure, a woman has to be done with her childbearing. Does this have anything to do with perimenopause and getting her ready for that time of life?
Dr. Koning: Well, not necessarily. If they're done with their childbearing and they're sure they don't want to have more children later, then it is an excellent procedure, even if they're younger and theoretically, sometimes the periods can return after five years or longer, but if they're close to menopause, that's even better. The results are even better because they're near menopause anyway, so if you can get some time of two to three to five years, then they can avoid hysterectomy, which is our goal.
Melanie: And then, give us just a little bit wrap up for us of what red flags when a woman is bleeding--because our periods can be heavy and they can be light--when do you recommend this procedure?
Dr. Koning: Yes, if a woman's used to having periods say, four to five to six days, if they're used to that and they start to have either longer periods or changing their feminine hygiene more frequently, or if they're bleeding in between their periods, then they definitely need to have a checkup by a gynecologist to see what's going on and to, of course, rule out cancer, rule out fibroid tumors, and rule out endometriosis and other problems. So, not every woman will be a candidate for an endometrial ablation, but many, many women have had in the past, quite frankly, have had hysterectomies when probably this simple, quick ablation would be much more helpful and much less risky and much less complicated.
Melanie: Does Novasure change the hormones in a woman?
Dr. Koning: No. It really doesn't at all because the ablation is done on the endometrial lining inside the uterus well away from the ovaries, so there's no change in hormones.
Melanie: And, will they still have a period afterward?
Dr. Koning: Probably about half of the women still have some bleeding, but it's much improved, about 95%, have shown by all the research has shown that about 95% of women are very happy with the results, such that they go back to their normal period, or just a spotty, maybe two or three days of spotting rather than the heavy changing tampons and pads every hour and so forth. So, most women are very happy with the procedure.
Melanie: Would they still use birth control after having endometrial ablation?
Dr. Koning: Yes, actually, they still need birth control. So, if their partner has had vasectomy, or if they've had a tubal ligation, or they may still be need to be on other methods of birth control, but endometrial ablation, itself, is not birth control. So, that has to be discussed with their gynecologist prior and then after the procedure to determine what would be best for them.
Melanie: What about sexual relations after this procedure?
Dr. Koning: We usually say about two weeks is average, because there could be some drainage and very, very slight chance of infection. I've never seen an infection after an endometrial ablation. I've probably done over a thousand ablation and there have been no complications. It's a very safe procedure, but to avoid any chance of infection, it would be good to have no relations and we say nothing in the vagina for two weeks.
Melanie: And, in just the last few minutes, Dr. Koning, what should people with pelvic pain or heavy bleeding think about when seeking care?
Dr. Koning: Well, I think they have to find a doctor they trust. Again, I think many women are a little bit fearful of seeing the gynecologist because all they really now about is either strong hormones or a major operation where they're going to be off work for many, many weeks and so forth. So, many women are not even familiar with the concept of going in for a quick, simple procedure that stops their period or improves their bleeding. So, I think they have to, if you will, shop around a little bit and find somebody they trust and go through all the different questions they would have and then they could choose to make the right the decision for themselves.
Melanie: And, why should they come to Corona Regional Medical Center for their care?
Dr. Koning: Well, quite frankly, Corona is a relatively smaller hospital, but it's very good at basic procedures, such as basic gynecologic procedures, such as ablations and procedures such as that and so I think it's an excellent place to go. It's home like and the nurses are excellent and friendly and the facility is excellent. I think they're going to have a good experience there for sure.
Melanie: Thank you so much for being with us today, Dr. Koning. You're listening to Corona Regional Radio with Corona Regional Medical Center. For more information, you can go to CoronaRegional.com. That's CoronaRegional.com. Physicians are individual practitioners who are not employees or agents of Corona Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Do You Suffer from Pelvic Pain?
Melanie Cole (Host): There are many changes that can occur in a woman's body during the course of her life that may result in heavy bleeding or pelvic pain. My guest today is Dr. Lawrence Koning. He specializes in obstetrics and gynecology and is a member of the medical staff at Corona Regional medical Center. Welcome to the show, Dr. Koning. What are some reasons a woman might have pelvic pain or heavy bleeding?
Dr. Lawrence Koning (Guest): Well, there are a lot of reasons women have pelvic pain. More commonly, though, is that they have heavy bleeding. Most women do, to be honest, hate their periods, so there are a number of ways to treat that, but pelvic pain can be caused from endometriosis; it could be caused from tumors such as fibroids, or just basically heavy periods, which is very common.
Melanie: So, how would we know that this pelvic pain--when do we go see a doctor if we are suffering, because, sometimes hormone levels or things can cause pain in the pelvis.
Dr. Koning: Well, almost all women will occasionally have a heavy period or pelvic pain and cramping with their period, but if they start having increasing pain, or certainly if their periods are longer than usual--more than four to five to seven days--and they're having clotting and changing their feminine hygiene more than every one or two hours, certainly that's the time to go see the gynecologist.
Melanie: What would be the first line of defense if a woman did come to you and say she has pelvic pain or heavy bleeding?
Dr. Koning: Well, the most important thing is to get a complete history and physical. Of course, it depends on the woman's age and what her childbearing desires are--if she's already had kids or wants more kids, those are certainly important things depending on what all of her symptoms are. If they have pelvic pain and they're very young, they can usually--of course, they need an ultrasound, a physical exam, more of a history to determine how long the pain has been going on, if it's related to various things and activities they're doing, such as sexual intercourse or other activities. Or, if it's just mild pain and cramping with their periods, then that can be much less serious, but certainly the first step is to get an appointment with some gynecologist they trust and have an exam and have a history and have some imaging, such as ultrasound, which is very safe, and then go from there and determine what the next choices would be.
Melanie: So, tell us about one of those choices: endometrial ablation. What is that?
Dr. Koning: Well, endometrial ablation is one of my personal favorites because it is so safe and simple. It's a very quick outpatient procedure. The actual procedure takes about 10 minutes and I almost like to liken it to a microwave. It sounds maybe a little unusual to a woman the first time, but rather than having a hysterectomy and, quite honestly, many women don't want to even to go to the gynecologist because they're afraid they'll get rushed to a hysterectomy. I've found if you sit with them and explain how simple the ablation is--it's a very simple outpatient procedure that takes about ten minutes, and it is very effective, and so it's one of our favorites to stop heavy bleeding. They do have to be finished with their childbearing, so it depends on their situation, age and how many kids they have, but it is a very effective procedure.
Melanie: And, if somebody is a candidate for endometrial ablation, what's the procedure like?
Dr. Koning: Oh, it's very simple now. Sometimes we are able to do those in the office but, typically, we'll do those in the hospital. It's a little bit safer that way with the anesthesiologist present. There is light anesthesia where they're sedated, and then they have local anesthesia around the cervix, but the actual procedure is about 8-10 minutes where we take a look inside with a camera inside the uterus and then a device called a “Novasure Endometrial Ablation Device” is placed in there for about typically a minute to a minute-and-a-half and that basically cauterizes the inside lining of the uterus which may sound a little unusual, but it actually very, very safe and the results are very remarkable.
Melanie: What is it like for a woman afterward?
Dr. Koning: There's very little cramping afterwards, maybe for a couple hours, and we give them some pain pills, typically. They can go home just within an hour or two after the procedure and then they may have some little drainage or discharge for up to a week or two, sometimes slight drainage for longer than that, but typically it's sometimes just for a few days.
Melanie: You mentioned when you were speaking about candidates for this procedure, a woman has to be done with her childbearing. Does this have anything to do with perimenopause and getting her ready for that time of life?
Dr. Koning: Well, not necessarily. If they're done with their childbearing and they're sure they don't want to have more children later, then it is an excellent procedure, even if they're younger and theoretically, sometimes the periods can return after five years or longer, but if they're close to menopause, that's even better. The results are even better because they're near menopause anyway, so if you can get some time of two to three to five years, then they can avoid hysterectomy, which is our goal.
Melanie: And then, give us just a little bit wrap up for us of what red flags when a woman is bleeding--because our periods can be heavy and they can be light--when do you recommend this procedure?
Dr. Koning: Yes, if a woman's used to having periods say, four to five to six days, if they're used to that and they start to have either longer periods or changing their feminine hygiene more frequently, or if they're bleeding in between their periods, then they definitely need to have a checkup by a gynecologist to see what's going on and to, of course, rule out cancer, rule out fibroid tumors, and rule out endometriosis and other problems. So, not every woman will be a candidate for an endometrial ablation, but many, many women have had in the past, quite frankly, have had hysterectomies when probably this simple, quick ablation would be much more helpful and much less risky and much less complicated.
Melanie: Does Novasure change the hormones in a woman?
Dr. Koning: No. It really doesn't at all because the ablation is done on the endometrial lining inside the uterus well away from the ovaries, so there's no change in hormones.
Melanie: And, will they still have a period afterward?
Dr. Koning: Probably about half of the women still have some bleeding, but it's much improved, about 95%, have shown by all the research has shown that about 95% of women are very happy with the results, such that they go back to their normal period, or just a spotty, maybe two or three days of spotting rather than the heavy changing tampons and pads every hour and so forth. So, most women are very happy with the procedure.
Melanie: Would they still use birth control after having endometrial ablation?
Dr. Koning: Yes, actually, they still need birth control. So, if their partner has had vasectomy, or if they've had a tubal ligation, or they may still be need to be on other methods of birth control, but endometrial ablation, itself, is not birth control. So, that has to be discussed with their gynecologist prior and then after the procedure to determine what would be best for them.
Melanie: What about sexual relations after this procedure?
Dr. Koning: We usually say about two weeks is average, because there could be some drainage and very, very slight chance of infection. I've never seen an infection after an endometrial ablation. I've probably done over a thousand ablation and there have been no complications. It's a very safe procedure, but to avoid any chance of infection, it would be good to have no relations and we say nothing in the vagina for two weeks.
Melanie: And, in just the last few minutes, Dr. Koning, what should people with pelvic pain or heavy bleeding think about when seeking care?
Dr. Koning: Well, I think they have to find a doctor they trust. Again, I think many women are a little bit fearful of seeing the gynecologist because all they really now about is either strong hormones or a major operation where they're going to be off work for many, many weeks and so forth. So, many women are not even familiar with the concept of going in for a quick, simple procedure that stops their period or improves their bleeding. So, I think they have to, if you will, shop around a little bit and find somebody they trust and go through all the different questions they would have and then they could choose to make the right the decision for themselves.
Melanie: And, why should they come to Corona Regional Medical Center for their care?
Dr. Koning: Well, quite frankly, Corona is a relatively smaller hospital, but it's very good at basic procedures, such as basic gynecologic procedures, such as ablations and procedures such as that and so I think it's an excellent place to go. It's home like and the nurses are excellent and friendly and the facility is excellent. I think they're going to have a good experience there for sure.
Melanie: Thank you so much for being with us today, Dr. Koning. You're listening to Corona Regional Radio with Corona Regional Medical Center. For more information, you can go to CoronaRegional.com. That's CoronaRegional.com. Physicians are individual practitioners who are not employees or agents of Corona Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.