Image: Bing Fang | Written by: Aunt Weng | Editor-in-Charge: Ah Yue
Hello, everyone, I'm Ah Yue.
Some time ago, in our tree hole message, I saw such a message, which probably means that in the family of father and daughter, the younger sister is an intellectually disabled person, and the sister works outside the home to earn money for many years in order to support this family. My sister heard that endometrial ablation could keep my sister from menstruating, so in order to reduce the inconvenience of my father taking care of my sister, I came to consult whether such surgery could be done.
So, can endometrial ablation be done? Can you really do it once and for all and never menstruate again?
Today, we will invite the obstetrician and gynecologist Aunt Weng to take you to understand endometrial ablation.
What is endometrial ablation?
Before talking about endometrial ablation, let's talk about a common gynecological disease: abnormal uterine bleeding, which is often referred to as "menstrual disorders" or "heavy bleeding". This abnormal bleeding directly affects the quality of life of women, and if it is serious, there will be anemia, infection, and shock.
Some of the causes of the disease are related to organic diseases, such as uterine fibroids, adenomyosis, endometrial polyps, endometrial cancer, etc.; some are related to endocrine disorders, such as irregular ovulation, polycystic ovary syndrome, etc.; some are related to abnormal coagulation function, such as aplastic anemia, abnormal coagulation factors, thrombocytopenia, etc.
Clinically, it is often necessary for the doctor to first determine the cause of bleeding, and then give corresponding treatment according to the cause. If it is caused by diseases such as fibroids and polyps, it is targeted to treat the disease, such as surgical removal; if it is caused by endocrine disorders, it is often necessary to take hormones to adjust the menstrual cycle; if it is caused by abnormal coagulation function, it is necessary to work with obstetricians and gynecologists and hematologists, and most of them also choose drug treatment.
However, some women, or because the body is not competent for major surgery or drug treatment, or because of subjective willingness to choose major surgery or drug treatment, then they can reduce the amount of menstruation or amenorrhea by destroying the endometrium, which is endometrial ablation.
How is endometrial ablation performed?
Endometrial ablation is the use of surgical methods to destroy the endometrium.
This procedure can be done by removing the endometrium by electrocustomy instruments under direct view of the minimally invasive endoscope. Non-electrocuting microscopic removal devices may also be used to damage the endometrium. The endometrial ablation, which was asked by the reader at the beginning of the article, is a non-electrocuting method.
It is through a bipolar radio frequency device, output radio frequency energy (a type of electrical energy) until it reaches and destroys the endometrium, often referred to as NovaSure in China. The mesh electrode device of the device is inserted into the uterine cavity, the mesh is unfolded so that it is attached to the endometrium, and the radio frequency energy during operation can destroy the endometrium, the average treatment time is slightly more than 1 minute (about 90 seconds), and the average depth of tissue removal is 4 to 5 mm. The mesh electrode resembles a fan, and this shape is also an inverted triangle that mimics the uterine cavity.
▲Image source: Drawn by the eleventh consultation room
According to the depth of the uterine cavity of different women, there are different models, the most ideal is that the electrode and the shape of the uterine cavity are completely matched, so that the endometrium can be fitted to the electrode to the greatest extent, and the intima can be destroyed to the greatest extent after energization.
Of course, this assumption is ideal, and everyone's uterine cavity morphology is different, so the NovaSure system has certain requirements for the uterine cavity and uterine opening. It is necessary for the uterine cavity to have a certain depth, but not too deep to ensure that the fan surface is exactly inside the uterine cavity; a certain distance is satisfied between the uterine angles on both sides to ensure that the "fan" can be fully opened.
If there are fibroids or polyps under the mucous membrane, the fibroids or polyps need to be removed first, and the irregular morphology of the uterine cavity will also affect the effect of surgery.
What kind of person is suitable for endometrial ablation?
What kind of people can benefit the most from this treatment?
Medically, it is believed that the main adapt group of endometrial ablation is to treat menorrhagia caused by premenopausal benign diseases, especially in women whose physical condition cannot be stopped by other methods (such as drugs or other surgeries).
Endometrial ablation is not suitable for women who wish to amenorrhea for non-medical reasons, because many women do not have amenorrhea after endometrial ablation, and some studies have shown that the amenorrhea rate of patients undergoing Nuoshu endometrial ablation is 30% to 75%, which means that some women only have a decrease in menstrual flow and do not reach the point of no menstruation at all.
What are the considerations?
First of all, it is necessary to understand some surgical contraindications, and the following conditions cannot be done endometrial ablation.
Pregnancy.
Known or suspected endometrial hyperplasia or endometrial cancer. (Endometrial cancer requires surgery far beyond the removal of the intima))
Desire to preserve fertility. (The sister in the article hopes that the operation will reduce the sister's dilemma, but the operation may lead to the loss of the sister's fertility, and whether the guardian has the right to make such a decision needs to be decided by a legal or ethical professional.) ）
Active pelvic infections, surgery may lead to further spread of the infection.
There are IUDs that require loop removal before surgery.
There are anatomical or pathological weaknesses in the uterine muscle layer, such as a history of classical caesarean section or transmural fibroid removal; such procedures may result in thinning of the uterine muscle layer, which may cause damage to adjacent internal organs (bladder, intestine) if the energy used for removal passes through the uterine tissue.
▲ Image source: Giphy
The most common short-term complications of endometrial ablation are uterine perforation, bleeding, uterine hemorrhage, and pelvic infection. The reason is that there may be adhesions in the endometrium after surgery, resulting in local blood accumulation, some of which are associated with improper manipulation or individual factors that lead to unsatisfactory treatment results.
There are two main types of postoperative long-term complications: recurrent yin tract bleeding and periodic pelvic pain, which may appear immediately after surgery or several years after surgery. The first reason may be that the endometrium is not completely removed during surgery, and the second reason may be the regeneration of the endometrium after surgery. Periodic pelvic pain occurs months or years after surgery and may be caused by bleeding from the yin tract, or it may be blood accumulation in the uterine cavity or even at the uterine horn.
Finally, to summarize with you, endometrial ablation is a minimally invasive operation that uses radiofrequency energy to destroy the endometrium, and is mainly used in women with multiple menstrual periods caused by benign diseases and no fertility requirements. The doctor needs to evaluate whether the patient's uterine cavity is suitable for this technique before surgery, and the purpose of reducing menstrual flow and even menopause can be achieved after surgery.
In the story at the beginning of the article, the sister wants her sister to have surgery, from a medical point of view, there is no medical indication, and as a guardian of the mentally disabled, whether she has the right to give up the right to reproduce for the person needs to be further discussed with legal and other professionals. Even if surgery can be done, there may be places that are inconsistent with expectations, such as surgical complications, such as bleeding after surgery or pelvic pain, etc., which must be fully understood before surgery.
▲Image source: soogif
What should I do if I want to postpone my period due to a special event?
When it comes to wanting to intervene in menstruation, many women may be more concerned about encountering some special events in their lives, such as exams, vacations by the sea, and the need to postpone menstruation.
The two most common methods of delaying menstruation are recommended: the first is to take progesterone, such as progesterone capsules, which are started a week before menstruation until the end of the special event, and the disadvantage of this method is that the effect is not necessarily reliable, that is, it does not necessarily hold on, and the later the start time of the use, the higher the failure rate.
Another method is oral contraceptives, theoretically take oral contraceptives during the period, is not menstruating, the disadvantage of this method is that some women in the first cycle of the first dose will have a small amount of bleeding in the yin tract, continue throughout the medication period, if you need to swim in the water, this method may not be suitable, it is best to adjust the time of menstruation through oral contraceptives in the previous menstrual cycle.
The special structure of the female body creates a series of physiological reactions. And menstruation may be a physiological phenomenon that every girl will experience, and we don't have to change it for non-medical reasons.
If it is due to menstrual pain and physical discomfort, it is recommended that girls go to the hospital in time to check and improve in the right way.
If you really like the girl at the beginning, there are all kinds of inconveniences in life, and I hope that it can be solved in a more realistic way that has less harm to the body.
Be sure to choose the way of surgery to intervene in menstruation, but also carefully understand the surgical process, complications, precautions, etc., so as to be responsible for yourself.
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