Women's Health Community

I don't know about these specific procedures but the outcome of any ablation depends partly on your situation (e.g., uterine abnormalities, whether or not you've had a tubal ligation, age, etc.). Here's a discussion of many women's experiences with ablation - http://forums.webmd.com/3/gynecology-exchange/forum/12649/55#55.

Dear An: Anon has spoken correctly. Here is some additional information.

Most current endometrial ablation (EA) techniques can be "blind" without direct visualization of the lining. This means that this type of EA can be done in the GYN's office. The GYN may not need to utilize fiber optic scope skills. Such procedures include:
ThermaChoice—hot water (190? F) in a balloon inside the uterus
HydroThermAblator—circulating hot water (190?) directly inside the uterus
Her Option---freezing or cryo destruction of the lining
Microsulis---microwave heated destruction
NovaSure---mesh net triangle which conducts a bipolar radiofrequency

There are MANY studies which have compared at least two of these methods to see if one method is superior, or works better with a certain type of patient. For example 126 women were randomly assigned to NovaSure or ThermaChoice procedures. Five years after procedure, no further menstruation ("amenorrhea") was reported by 48% in the mesh net group and 32% in the balloon group. Unfortunately, most of the comparison studies have had small numbers of women.

According to the largest review (http://www.ncbi.nlm.nih.gov/pubmed/19821278 ), there were no overall differences in patient satisfaction or bleeding outcome between all the first and second generation EA procedures. The advantage of the newer techniques were decreased risks for perforation through the wall of the uterus, less fluid overload, fewer tears of the cervix, and cervical scars which close off the cervical canal. However women were more likely to have nausea, vomiting, and cramping.

So if type of EA procedure seems to be generally equal, can we identify specific women who might not have as good an outcome based upon her medical history or personal anatomy? You may have read that large fibroids sticking out into the uterine cavity can impede the correct placement of NovaSure, or that a very large uterine cavity (e.g., greater than 5 inches) can be harder to treat.

Physicians from the Mayo Clinic (http://www.ncbi.nlm.nih.gov/pubmed/19104365) reviewed the outcomes of 816 women who had an EA. Factors which seemed to predict successful stopping of all bleeding ("amenorrhea") included: age 45 or older (menopause would be kicking in within 5 years or so), a thin uterine lining of less than 4 mm, normal size of uterine cavity (less than 9 cm), and use of NovaSure type rather than heated balloon. Patient characteristics linked to treatment failure were: age younger than 45 years, five or more pregnancies (leads to larger uterine size), prior tubal ligation, and history of bad menstrual cramps. Of note, 5% of their women had complaints of pelvic pain after their EA procedure. Among that 5% of women with persisting pain 40% had retained fluid within the uterus—referred to by the authors as "postablation syndrome."

Bottom line, unless you have some specific, predisposing factor (eg fibroid inside the cavity), you are probably best off to go with the EA procedure in which your GYN is most experienced.

Yours,
Jane

Thank you so much. This has been very insightful and will definitely help me make a much more informed decision.