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Deborah:  Question, what do hormones, ablations and in-office procedures all have in common? Well, it just might be that the three things together could mean a much more comfortable life for you. And today, we'll explore that. This is the podcast series from Deaconess, The Women's Hospital, a place for all your life.

I'm Deborah Howell and our guest today is Dr. Constantine Scordalakes, a board-certified OB-GYN at Women's Health Care, PC at the Women's Hospital. Welcome, Dr. Scordalakes.

Dr. Constantine Scordalakes (Guest): Hi, thank you for having me.

Deborah: Great to have you on the podcast today. My first question to you is what actually is an endometrial ablation?

Guest: Excellent question. So, one of the ailments or conditions that sometimes can affect women is a heavy or a painful period, heavy or painful menses. And so an endometrial ablation is a treatment to try and help these patients and help these women to accomplish a better period, a more comfortable or lighter bleeding cycle.

Deborah: Great. And who would benefit from an endometrial ablation?

Guest: Any female that is having cycle that is heavier than she would like could potentially benefit from this procedure.

Deborah: Let's talk about recovery time for an endometrial ablation. How long?

Guest: Well, endometrial ablation is a minimally invasive procedure. We are not making any incisions whatsoever. And so that really helps with the recovery time. It's going to vary somewhat from person to person. We all experience pain differently and react differently to pain. But in general, I would say the day of the procedure is really the only day of recovery. By the next day, most patients will tell me that they felt almost back to normal.

Deborah: Incredible. Now, can having an ablation sort of mess with your hormones a little bit?

Guest: Luckily, it does not whatsoever. The hormones in a female's body are produced by the ovaries. And the ovaries are not at all bothered, manipulated or affected by this procedure. This procedure only involves doing something to the lining of the uterus.

Deborah: Okay. Now can an endometrial ablation cause early menopause or is that kind of a myth?

Guest: I would say that's most definitely a myth. Again, we are staying far away from the ovaries. We're not interfering with the ovaries or the blood supply to the ovaries. And so it's essentially impossible with the way that we perform this procedure that we could somehow affect the ovaries and cause them to decrease in their function, which then of course could possibly lead to menopause.

Deborah: And can an endometrial ablation be done right there in the office?

Guest: Absolutely. It can be done in the office or in the hospital setting. It just depends on the specific situation for that patient. When it is done in the office, of course, it offers some wonderful benefits for the patient. Oftentimes, it's less expensive and more cost-effective for the patient. Secondly, it can be done in a more efficient manner. There's less waiting and checking in. You don't have to be in a hospital setting sometimes around other patients that might be sick or unwell. And it's a more personal intimate environment than sometimes the hospital setting can be.

So the other benefit to having it done in the office is that, at least in our facility, we offer anesthesiologists there to help with the patient's pain and make sure that the patient is completely comfortable. Because there is some degree of pain associated with the procedure, it is important to address that and make sure the patients are very comfortable during the procedure.

Deborah: Okay. Is it more like a twilight situation?

Guest: So we address the pain on two fronts. One is that we inject at the cervix locally with some medication that will help numb that area locally. And then there is an IV and, through the IV, we can also give additional pain medication as needed for pain that arises during or after the procedure.

And again, each facility is different, but at least at our facility we do have a board-certified anesthesiologist that is attentive to the patient, their breathing, their vitals and their pain to really optimize and give those patients a most exceptional experience.

Deborah: So they are somewhat sedated?

Guest: Most patients are breathing on their own, but they are sleepy. And a lot of times patients will have sort of finished the procedure and then I'll tell them, "Everything went well. I'm going to go talk to your family." And they'll look at me and say, "Did you start yet?" So they're so comfortable that they don't even realize the procedure happened.

Deborah: They're awake, but they don't care.

Guest: Yeah, I guess you could say that.

Deborah: That's awesome. Because then, you know, an hour or two later, they're feeling somewhat normal, right?

Guest: Right. I think patients will experience the most pain once the sedation, if you will, wears off and they're more awake. They are going to experience some degree of cramping at the uterus. And it's usually the worst just right after the procedure. After about 15, 20 minutes, there's a significant decrease in the amount of cramping and patients feel better much faster. I always use the example of one of our office staff here. She brags that she had the ablation in the morning and was back at work by lunchtime.

Deborah: Her drive-by ablation.

Guest: That's right. I may have to coin that term.

Deborah: That's great. And then the following month, instead of a big, heavy, awful period, what happens?

Guest: Excellent question. So again, it depends on the technique used, what type of ablation, because there's different types, there's different ways to do it. But on average or at least with the technique that we use, about 30% of patients will never have another period again. And things that affect that are your age, if you're younger, you're more likely possibly to not be one of those 30%. If you're older or closer to menopause, you may be more likely to be one of the 30%. So about 30% of patients, no bleeding ever again.

So the majority of patients will still have some type cycle. Of those 70% though that do have some type of bleeding, 90% will be happy because the production and the bleeding will be enough that they're happy with the results. And unfortunately, we always have a small number of patients who will not be happy with the result or don't have as much of a reduction as they hoped for.

Deborah: Can't ask for more than that, 90% are happy and 30% are free forever. You're doing a good job.

Guest: Yes, we try. We try.

Deborah: Is there anything else you'd like to add to some of the more benefits a woman can expect after an ablation?

Guest: Certainly, in this day and age where I think definitely have women more in the workplace and sometimes they are the primary breadwinners, if you will, for their families, it's difficult for them to be away from work. And so if we can offer them a procedure that improves their quality of life, the benefits of not bleeding heavy, not getting anemic, not having accidents with her clothes or in the car or other embarrassing events, if we can improve on that and get patients back to work by the next day, I think that's a huge success and one that unfortunately we can't offer such a quick return back to work if they do something else like a hysterectomy.

Deborah: Okay. Fantastic. And especially for female athletes. So important to look into this if you are struggling right now. Thank you so much, Dr. Scordalakes, for taking us inside the world of endometrial ablations and giving us a true picture of how patients can benefit from them.

Guest: It's been a pleasure. Thank you for having me.

Deborah: That wraps up this episode of the podcast series from Deaconess The Women's Hospital, a place for all your life. To learn more or to make an appointment, head on over to WHCPC.com. And for more health tips and updates, follow us on your social channels. I'm Deborah Howell. Thanks for listening and have yourself a great day.