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Thursday, October 14, 2010

Endometrial Ablation Techniques Compared

There are several technologies in use today for endometrial ablation, and those in use have been tested and reported as extremely effective. It is up to your gyno, in consultation with you, to select the procedure she or he thinks will be a successful treatment. There are often choices to be weighed, and this short post is not going to cover them all of course! An interesting article was just published in the October journal called Obstetrics and Gynecology by a group headed up by Dr. Penninx from a research medical center in Amsterdam. What they found was that using the bipolar radiofrequency device was more effective than using the hydrotermablation technique. The NovaSure bipolar technique is a wand of relatively set configuration and it is performed "blindly" after insertion. The HydroThermAblator (HTA) is a technique that is performed while still watching with the view of the hysteroscope (telescope seeing in the uterus). The surgeons compared a study that looked at two groups that conformed to routine diagnosis of heavy bleeding. All of these patients were before menopause and were scheduled early in their cycle. They studied about 80 women in each group, and were able to get information on most up to a year. At 6 months out 19 of the women in the HTA group had to have other procedures and only 5 in the NovaSure group. Not quite half of all women in the bipolar group were no longer having a period at a year, which is what you expect, some studies have showed slightly better for complete period absence. The HTA group had lower success rates. In this study the HTA group was not pretreated with medicine to thin the lining. Higher success rates can be expected if women either can, or are willing to use hormonal pretreatment. Some physicians will treat with hormones in the healing phase, this theoretically may help as much. They do not specifically report the term post ablation syndrome, but there were cases of hysterectomy in the follow up phases.The study has a lot of interesting detail, it reaffirms how safe and reliable the procedures are, and does seem to back up the selection of the NovaSure device for most women who fit the criteria in this study. We will watch to see if they publish long term data as many of my gyno gabbers ask about long term success which is an important question.

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