Already Had an Endometrial Ablation, When to Do It Again

Many women have had an endometrial ablation that worked, and now the bleeding has returned. Womens will report that they may notice this quickly: within a few months of their procedure or it may occur over several months. It is more common to have light periods after a few years than no periods at all after an ablation was done. Many of the women who have had a recurrence of their menstrual woos are contemplating their second procedure. Usually a hysterectomy is not the first choice of treatment when the menstrual cycles recurr after an endometrial ablation, even if the new cycles are painful or have PMS. There are a number of choices of therapies and new ones being developed. For some women, it's time to move on to Mirena IUD, birth control pills, Lysteda or a hysteroscopy with Myosure. And yes, for a small percentage of women hysterectomy should be considered. All these have a roll for some women, and none are the solution for all. For many just repeating the prior NovaSure, or whichever procedure you started with can be the most successful. But there are also other ways to perform an endometrial ablation. There have actually been technological improvements to the NovaSure device, the Thermachoice Balloon and Genesys HTA System from Boston Scientific used for the treatment of menorrhagia or heavy menstrual bleeding (which affects approximately 10 million women in the US according to Medscape). With device improvements it's not as likely to ever need a second procedure. Most of the devices we use for endometrial ablations haven't had extensive testing in the second round (a second therapy if the bleeding has resumed), but it's good to know that improvements are coming. So if you had a successful endometrial ablation, but gradually your symptoms have returned, you may just need to be retreated. And before you leap to your next treatment, questions for your gyno: do I need a biopsy of my lining, or a saline infusion sonogram, or a 3D ultrasound, or an extra pap smear or some cultures! And ask if medical therapies are an option for you. Remember, test before you treat to make sure that second time ablation is really what is best!

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