Keep Your Uterine Lining or Do Ablation, What are Some Considerations

Women who have heavy bleeding are told to consider eliminating the uterine lining. The uterine lining is medically called the endometrium, and it is designed to be the lush baby bed. Originally, or as scientists like to say "ontogenetically" shedding the lining in the way of menstrual blood is to keep it fresh and ready for the next pregnancy. But I like to think of those menstrual periods as the first' blue stick' tests we had. We just needed that firm signal once our roles changed from ready to have a baby to baby present. So the lining is shed monthly, it's not destroyed permanently in the 'natural' premenopausal state. Of course we go back far enough in time women didn't actually have many of those shedding episodes at all. Women in cave times had about 20 menstrual cycles in their life, and now we have about 400.
They were pregnant, they were breast feeding, they were malnourished, and no periods. Then physicians came up with a thought. Gynecologists noting that when women after severe infections got scaring and damage that wasn't reversible, modern technology took those lemons and made lemonade! The purposeful creation of a useless lining that would just be scar tissue and not something that could be shed.  The technique of ablation takes that shedding a bit farther, it destroys the ability to regenerate. When and why to have the procedure has also evolved.
The surgery can be performed by manually remove the tissue with a rollerball or rollerblade aimed through the hysteroscope and attached to heat. Or other ways of doing the surgery include the NovaSure, the Thermal Choice Balloon, the HydroThermAlate HTA or a cryosurgery device. From women in the past who only had this done as a "last resort" to women having this as their first line treatment for unwanted bleeding. TeLinde's Gynecologic (one of the leading gyno books) text says "there has been significant disagreement regarding the appropriate indications for this procedure," and we'll mull that one over later. Are we trying to say here that women shouldn't have control over their bodies? We wouldn't be hinting that its' actually not up to us to say when to just say NO to your menstrual periods? WWYIC say....(insurance company)? ACOG since their position paper in 2007 says:
  • Endometrial ablation is indicated for the treatment of menorrhagia or patient-perceived heavy menstrual bleeding in pre-menopausal women with normal endometrial cavities who have no desire for future fertility.
  • The presence of anemia or failure or intolerance of medical therapy are important considerations but should not be construed as prerequisites for the procedure.
Well, first when you are considering having an ablation, be sure there is no contraindication, like a cancer of the lining, a polyp, or infection. Also some women with polyps and fibroids may be treated with other or additional techniques. And how anemic are you is another consideration before having the procedure. Women with sight anemia will tolerate the surgery well in many cases, severe anemia may need to be treated first. Make sure your pap is current. But after that, lets sit down Gyno to Girl, and Gab.


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