Balloon Thermo-ablation
Dr G.D. Reid & Dr H.F. Joyce


Balloon thermo-ablation of the uterus is a method of controlling menorrhagia (heavy periods) by destruction of the endometrium (lining of the uterus). The endometrium is destroyed by heating, leaving only myometrium (muscle) and fibrous tissue. When the endometrium sheds at the time of menstruation, a thin basal layer is left from which the endometrium regenerates during the next cycle. The aim of thermal ablation is to destroy this basal layer so that no regeneration occurs.


Suitability for Balloon Thermo-ablation
It is an alternative to hysterectomy in many women with heavy periods, and is also of value in post-menopausal women who bleed heavily with hormone replacement therapy.

It is not suitable for patients who:

The Procedure
Either a general anaesthetic or an epidural anaesthetic is used during the procedure, which therefore requires admission to hospital or a day surgery unit.

A telescope (hysteroscope) is passed into the cavity of the uterus through the cervix. A camera attached to the end of the hysteroscope transmits a high quality image to a video monitor giving the surgeon a direct view inside the uterus.

After inspection of the uterine cavity, a sample of endometrium is removed and sent to the Pathologist for examination.

A latex balloon containing a central heating element is then passed into the uterine cavity and inflated with fluid to a pressure of 180 mm Hg. An electronic controller heats the fluid to 87° for 8 minutes, causing destruction of the endometrium.




After the Procedure
Most patients leave hospital after approximately 2 hours but occasionally an overnight stay is recommended. Because an anaesthetic is required a friend should pick up the patient, as a car should not be driven for at least 24 hours.

There may be some cramps or mild pain for 2 to 3 days, requiring analgesics, but normal activities can be resumed by the 2nd or 3rd day.

There may be watery, initially blood-stained discharge for 2 to 3 weeks, although occasionally this may last longer. Sexual intercourse should be avoided for about 2 weeks or until bleeding has stopped.


Results of the Procedure
Approximately 85% of patients will be satisfied with the outcome of their surgery. These are women whose periods stop or become significantly lighter. About 15% of women find that their menstrual loss becomes heavy once again, and most of these would have the procedure repeated or decide to have a hysterectomy.


Other Aspects
After Endometrial Ablation the uterus and cervix are still present so regular Pap smears should be continued.

The ovaries also remain and are not affected by this treatment. Hormonal production from the ovaries continues until the normal onset of menopause. Women taking hormone replacement after endometrial ablation should take both oestrogen and progesterone.

It should not be assumed that endometrial ablation will prevent pregnancy. While pregnancy is unlikely to occur, contraception should be considered as a separate issue. There is some evidence that pregnancies occurring after endometrial ablation have a high incidence of complication.


Risks of the Procedure
Complications are rare, especially when compared with other operations such as hysterectomy.

The following complications have been reported:

Costs
There is a charge for the balloon device used in this procedure, as this is a single use item. Most Health Funds will cover the cost of this, but it is wise to check beforehand.


Conclusion
Endometrial ablation offers a high rate of cure for heavy periods without having to remove the uterus. The short hospital stay and rapid convalescence makes this an attractive alternative to hysterectomy if this procedure is suited to the patient



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