Both UFE and ablation can be offered by specialists in treating uterine fibroids in women. It should be noted that whilst ablation addresses heavy vaginal bleeding of non-structural causes, it does not affect fibroids in any way. Today we want to give your a clear understanding of the indications and limitations of endometrial ablation vs. UFE in treating symptomatic uterine fibroids.
Endometrial ablation and uterine fibroid embolization (UFE) are two different procedures, although they are often mistaken for one another. Ablation is used to destroy a layer of the uterine lining while UFE is used to shrink and eliminate fibroids.
UFE Vs. Ablation: Key Differences
|Procedure performed by||An OB/GYN||An Interventional Radiologist (like Dr. John Lipman)|
|Addresses bleeding from||Non-structural causes, e.g. hormone issues||Structural causes, such as fibroids|
|The lining of the uterus||Is destroyed||Is kept intact|
|Will shrink or eliminate fibroids||No||Yes, 90% success rate on all fibroid types|
|Allows for Future Pregnancy||No||Yes!|
|Can treat Adenomyosis||No||Yes|
What Is Uterine Ablation?
Uterine ablation or endometrial ablation is a procedure performed by a gynecologist that is used most often to treat heavy menstrual bleeding which is why OB/GYNs often suggest it to women suffering from heavy bleeding due to fibroids. The procedure destroys a layer of the uterine lining and reduces or sometimes stops the flow of menstruation. Endometrial ablation does not treat or affect fibroids in any way.
How to Know If You Are Having Heavy Period Bleeding?
Women do not often share details when it comes to their menstrual cycles. So how do you know if what you experience during your menstrual cycle is normal? If you are experiencing any of these symptoms then you are most likely losing too much blood each month and should consult your doctor.
- Continually soaking a pad or tampon every two hours or less;
- You bleed for more than 7 days;
- You lose 80ml or more of blood during your period;
- You develop symptoms of anemia;
- You pass blood clots bigger than a quarter;
- Bleeding so much you cannot go anywhere.
Some more serious symptoms of menorrhagia are:
- Feeling dizzy or faint;
- Migraine-like headaches
- Chew/crave ice, corn starch, chalk, clay, or dirt.
- Increased heart rate;
- Low blood pressure.
Types of Uterine Ablation
Electrosurgery. Requires general anesthesia. An instrument such as a wire loop is used to carve thin trenches into the outermost layer of the lining of the uterus using heat.
Cryoablation. Uses extreme cold to freeze and destroy the top layer of the uterus. The doctor uses real-time ultrasound to guide and track their progress.
Hot fluid-free-flowing. Saline fluid is heated and used to “wash” the inside of the uterus for about 10 minutes. This process works best for women who have an irregular-shaped or distorted uterus.
Heated balloon. Uses heated fluid via a balloon device that is inserted through the cervix.
Microwave. A wand that emits microwaves is used to heat the outer lining of the uterus.
Radiofrequency. A device that emits radiofrequency vaporizes the tissue in just a few minutes. We’ve previously discussed in detail radiofrequency endometrial ablation in the article UFE Vs. Acessa™: What Should I Opt For?
Video: UFE Vs. Ablation: Is Endometrial Ablation a Good Option for Fibroid Treatment?
What to Expect From Uterine Ablation?
The uterus is accessed through the passageway between the vagina and cervix so incisions are not necessary for endometrial ablation. Sometimes the cervix must be dilated so the OB/GYN can gain access to the uterine lining. A surgical tool will be inserted into the passageway and one of many methods will be used to remove the outer lining of the uterus. Ablation can be done using a heated liquid, extreme cold, microwave energy, or high energy radiofrequency.
Depending on which type of ablation procedure is being performed, and the size and condition of your uterus, the doctor may do the ablation under general anesthesia or local anesthesia and could perform the procedure in their office or an operating room.
After the procedure you may experience:
- A watery/bloody discharge for a few weeks with the first few days being the heaviest.
- Menstrual-type cramps that over-the-counter medication may alleviate.
- You may feel the need to urinate more frequently for the first few days.
Uterine ablation is not recommended for:
- Certain abnormalities or disorders of the uterus.
- Cancer of the uterus, or an increased risk of uterine cancer.
- Active pelvic infection.
- Postmenopausal women.
- Recent pregnancy.
- Current or recent infection of the uterus.
Risks of uterine ablation include:
- Complications from anesthesia;
- Heat or cold damage to nearby organs;
- A perforation injury of the uterine wall or nearby organs;
- Future pregnancy is not recommended due to high risks.
Can Uterine Fibroids Be Treated With Ablation?
Sometimes endometrial ablation is suggested as a treatment for women with uterine fibroids that are causing heavy bleeding. Fibroids are a structural cause of heavy bleeding so ablation will only treat the heavy bleeding but will not address the fibroids or eliminate them. Since fibroids can continue to grow, heavy bleeding may continue as well as the other bulk symptoms of fibroids. If heavy bleeding is caused by a medical condition that is non-structural, then ablation may be an adequate treatment.
UFE Vs. Ablation: Future Fertility
Many patients who have had a uterine fibroid embolization procedure have had successful full-term pregnancies. In contrast, patients who would like to become pregnant should not have an endometrial ablation. Ablation is not a sterilization procedure, though many women can no longer conceive after having the procedure. Pregnancy is still possible; however, they are very high risk, maybe ectopic, and most end in a miscarriage. After having an ablation, most patients are urged to undergo sterilization or use long-lasting contraception.
Uterine Fibroid Embolization – Safer and More Effective Option
If you are experiencing heavy bleeding due to fibroids, Uterine Fibroid Embolization (UFE) is a non-surgical, outpatient procedure that treats all uterine fibroids regardless of number and size. Compared to endometrial ablation, UFE is more effective, less invasive, and allows women to keep their uterus and fertility option.
Dr. John Lipman is one of the world’s most experienced UFE physicians with over 9,000 procedures performed. Please visit ATLii.com for more information or make an appointment with Dr. John Lipman by calling Atlanta Fibroid Center at (770) 953-2600.