Maggie McKay (Host): Welcome to the Better Health Podcast, presented by Tidelands Health. I'm your host, Maggie McKay. Today, we're going to talk with Dr. Valerie Lasry, obstetrician and gynecologist about endometrial ablation surgery, who can benefit from it, how effective it is, what comes after surgery and more. Thank you so much for joining us, Dr. Lasry.

Valerie Lasry, MD: Thank you for having me.

Host: So right off the bat, what is endometrial ablation surgery and when is it typically recommended for patients?

Valerie Lasry, MD: Basically, it is recommended for anybody having really bad, heavy periods, and/or abnormal uterine bleeding. It also needs to be for patients who are done with their childbearing years, who do not ever want to have another pregnancy because the ablation is really a contraindication for pregnancy, because it would interfere with the baby's ability to implant in the uterus once the uterus has been burnt with the ablation.

So with women who do not want to be on hormones, for example, or who do not want to have an IUD and who do not want to have a hysterectomy, the ablation is a great way to fix your heavy periods so you can resume a normal life, go on about your activity or your work, and without having to worry about carrying extra pads and extra tampons and going through your clothes because your bleeding is so heavy.

Host: So, what is considered a heavy period and what could cause that?

Valerie Lasry, MD: A heavy period is what you perceive it to be heavy. In the past, we used to have a certain amount of CCs per hour or per day. But really now, we're basically saying if a woman judges that this period is very heavy for her, that is what we consider a very heavy period.

Things that typically can increase periods is age as we become premenopausal. Sometimes fibroids or thickening of the lining of the uterus, hormonal changes like polycystic ovarian syndrome can increase the heavy periods. There's all kinds of things that, through our life as women, can cause the heavy periods.

Host: And how effective is endometrial ablation in reducing heavy menstrual bleeding? What success rates are typically reported?

Valerie Lasry, MD: Well, that's the answer you're going to love. Ninety percent% of women who undergo an endometrial ablation will be thrilled of their results. They'll either have super light periods or no periods at all. And with the NovaSure ablation, pretty much, I usually end up with about 45-50% of patients who have no periods. And the remaining will tell me, "Oh my God, this is the best thing ever. Why did I wait so long to do it? My periods are like nothing."

Host: But like you said, if you are planning on having children, this might not be the way to go.

Valerie Lasry, MD: Correct. Absolutely. If you are still considering having pregnancies, then no, you should not have the endometrial ablation done. In fact, I actually tell patients if their partners or husbands have had a vasectomy, then they're fine to do it. Otherwise, I do encourage them to consider having a laparoscopic bilateral salpingectomy or a tubal ligation or their tubes removed, which is the salpingectomy at the same time as the ablation.

Host: How does endometrial ablation compare with a hysterectomy?

Valerie Lasry, MD: So, a hysterectomy is a major surgery. We're actually removing the uterus and cervix. I will say comparing the ablation to a hysterectomy, the ablation does not remove any organ. We are leaving the uterus intact. We are not touching the ovaries. We're not affecting the hormones at all. Where the hysterectomy, we're actually removing the uterus and cervix or the hysterectomy complete, we're removing uterus, cervix, and both tubes and ovaries.

So, the biggest issue is the risk of surgery. You can injure a bladder, you can have bowel injury, you can have ureteral injury, you can have a lot more infection risk or bleeding or hemorrhage, vaginal cuff infection, prolapse. Because as we lose part of that pelvic support when we do a hysterectomy, those things can lead to bladder prolapse, bladder drop as people refer to it, where the ablation doesn't do any of that. We're simply burning the lining of the uterus to make those periods either stop or be much, much lighter.

Host: Dr. Lasry, what should patients expect after they undergo endometrial ablation?

Valerie Lasry, MD: The beauty of the endometrial ablation is that it's a very simple procedure, very quick. It's done in an outpatient setting. The ablation itself is less than 90 seconds to a minute, minute and a half procedure. I do my ablations under anesthesia. So going through the anesthesia process and the actual hysteroscopy, which we do at the same time, so we start with doing a hysteroscopy, which is looking inside the uterus to make sure that the uterus looks good, looks normal. We scrape the lining of the uterus to get both sampling to confirm that there is no polyps, no cancer, et cetera. And then, we do the ablation, which is the actual procedure of burning the lining of the uterus. Once that's done, and like I said, it lasts less than a minute and a half, we wake you up. You go to the recovery room and you go home.

In terms of post-op pain, et cetera, what to expect? Basically, you're going to have some mild cramping, nothing that could not be taken care of with some ibuprofen or Motrin. I do send patients home with some hydrocodone in case they do need something a little stronger, but probably less than a day of menstrual cramping, and maybe some nausea from the anesthesia that can be also associated with some cramping and, usually, about a week to two weeks of some vaginal discharge as the lining heels post ablation. And basically, that is it.

In terms of potential risk or complications, the ablation is a very safe procedure. The NovaSure instrument that we use is a very safe procedure. It actually has a safety mechanism built in where, before we actually burn the lining of the uterus, there's a CO2 test that has to be passed to confirm that there has been no perforation done on the uterus before the burning happens. And why is that necessary? Because we don't want to burn anything outside of the uterus. And so if the CO2 test does not pass, the ablation doesn't happen. So if there was a tiny perforation in the uterus that the doctor did not recognize, the machine is smart enough to say, "Nope, sorry. Can't do the procedure until the test passes."

So, NovaSure is very safe. It actually senses, the machine senses when the burn has been complete. It's a process that we call impedance. And basically, it senses when the lining of the uterus has been thoroughly burnt. At that point, the procedure is complete. And that's why I say it's 90 to 120 seconds because it varies according to the size of your uterus, and the thickness of your lining.

So, it's suited for each, the machine basically will be modifying its length of thermal ablation based on the cavity size and the thickness of the lining, individualizing it for each patient as well as we also individualize the procedure by measuring the depth of the uterus and the endocervical canal to set the procedure as we need it to be in the operating room.

Host: What should patients know before considering this treatment? Before they even get it, what should they consider?

Valerie Lasry, MD: Right. So first of all, we usually always do a pelvic exam and a Pap smear to make sure that cervix is normal, that there's no cervical cancer. We also do a pelvic ultrasound and an endometrial biopsy. The endometrial biopsy is to make sure that there's no cancer or pre-cancer in the uterus, or that there's no large polyps. We do the ultrasound for making sure that the uterine cavity looks normal.

There's some abnormalities of the uterus where the NovaSure is contraindicated. So, for example, if a patient has a double uterus, what we call a bicornuate uterus, or if there's a large wall in the uterus that we call a septum, the endometrial ablation is not indicated for those circumstances because the instrument cannot open and take the shape of the cavity adequately. If you had a large fibroid that distorts the lining of the uterus, most fibroids are in the body of the uterus or on the outside of the uterus, but if you have a large fibroid that would distort the lining of the uterus, then also that would be a contraindication for an ablation.

Host: Well, thank you so much. This has been so eye-opening and educational. We really appreciate your time and you sharing your expertise.

Valerie Lasry, MD: Thank you.

Host: Again, that's Dr. Valerie Lasry. To find out more, please visit tidelandshealth.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening to the Better Health Podcast from Tidelands Health.