Fibroids and endometrial ablation
The real question that needs to be
considered when treating abnormal bleeding caused by fibroids is whether
or not additional surgery will be necessary even if the bleeding is
controlled. Fibroids that are inside the uterus (intracavitary
or submucous myomas) can often be resected (removed) at the time of an
ablation. Fibroids that are deep in the wall of the uterus cannot be
reached with a resectoscope. If large fibroids are causing pressure
and pain, then endometrial ablation won't solve these problems, and other
treatment would be necessary.
A more difficult questions is that of small
myomas in the wall of the uterus that are not currently causing any
problems. There is a chance that they eventually may grow and need surgery even if
bleeding is no longer a problem. On the other hand, there is a possibility
that they would never cause a problem. Factors to consider are the recent rate of
growth of the myomas and the age of the woman, since the closer she is to
menopause the less time they will have to grow. Thus a 48 year old woman with
moderately large fibroids that have been growing slowly may be a good candidate
for treatment of heavy bleeding by endometrial ablation. On the other hand, a 32
year old women with moderate size fibroids in the wall of the uterus that have
enlarged significantly in the last year would be very likely to need further
surgery after an ablation.
Combining endometrial ablation with
fibroid removal
Over half of the women on whom I do endometrial
ablations have fibroids. Before deciding to do an ablation on
someone with fibroids, we carefully look at the advantages and
disadvantages of all treatment alternatives.
Many fibroids that are totally or partially in the
cavity of the uterus can be removed with the resectoscope, allowing the
ablation to be completed in the usual way.
