Picture: Fang Bing| Written by: Aunt Weng| Editor in charge: A Yue
Hello everyone, my name is Ayue.
Some time ago, in our tree hole message, I saw such a message, which probably means that in a family of three father and daughter, the younger sister is a mentally handicapped disabled person, and the elder sister is a Support this family and earn money by working outside all year round. My sister found out that endometrial ablation can prevent my sister from menstruation. In order to reduce the inconvenience of my father taking care of my sister, I asked if such an operation could be done.
So, Can endometrial ablation be done? After doing it, can it really be done once and for all and never menstruate again?
Today, we invite Aunt Weng, an obstetrician and gynecologist, to introduce you to endometrial ablation.
What is endometrial ablation?
Before we talk about endometrial ablation, let’s talk about a common gynecological disease: abnormal uterine bleeding, also known as “menstrual disorder” or “Blood”. This abnormal bleeding directly affects the quality of life of women, and in severe cases, anemia, infection, and shock may occur.
The etiology of the disease is 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 factor, thrombocytopenia, etc.
In clinical practice, doctors are often required to diagnose the cause of bleeding first, and then give appropriate treatment according to the cause. If it is caused by diseases such as fibroids and polyps, it is necessary to treat the disease in a targeted manner, such as surgical resection; 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 Obstetrics and gynecology and hematologists join forces, and most of them also choose drug treatment.
However, some women, either because they are physically incapable of major surgery or drug treatment, or unwilling to choose major surgery or drug treatment, can by destroying the endometrium. To achieve the purpose of reducing menstrual flow or amenorrhea, this is endometrial ablation.
How does endometrial ablation work?
Endometrial ablation is the surgical destruction of the lining of the uterus.
This procedure can be done by removing the endometrium with a resectoscopic instrument under direct vision with a minimally invasive endoscope. The endometrium can also be destroyed using a non-resectoscopic removal device. The endometrial ablation that the reader asked at the beginning of the article is a non-resectoscope removal method.
It is a bipolar radio frequency device that outputs radio frequency energy (a kind of electrical energy) until it reaches and destroys the endometrium. It is often called NovaSure in China. Insert the mesh electrode device of the device into the uterine cavity, expand the mesh to make it adhere to the endometrium, the radio frequency energy during operation can destroy the endometrium, and the average treatment time is slightly more than 1 minute (about 90 seconds or so). ), the average depth of tissue removal was 4~5mm. The mesh electrode is like a fan, and this shape is also an inverted triangle shape that simulates the uterine cavity.
▲Image source: Drawing of the eleventh clinic
According to the depth of the uterine cavity of different women, there are different models. The ideal is that the shape of the electrode and the uterine cavity are completely consistent, so that the endometrium can fit the electrode to the greatest extent, and the endometrium can be destroyed to the greatest extent after electrification.
Of course, this assumption is an ideal state, and everyone’s uterine cavity is different, so NovaSure system has certain requirements for the uterine cavity and cervix. The uterine cavity needs to have a certain depth, but not too deep to ensure that the fan surface is just in the uterine cavity; a certain distance between the two sides of the palace corners is required to ensure that the “fan surface” can be fully opened.
If there are fibroids or polyps under the mucosa, the fibroids or polyps need to be removed first. The irregular shape of the uterine cavity will also affect the effect of surgery.
Who is suitable for endometrial ablation?
What groups of people would benefit most from this treatment?
It is medically believed that the main suitable population for endometrial ablation isthe treatment of menorrhagia caused by benign premenopausal diseases, especially if the physical condition cannot use other methods (such as drugs or other surgery) to stop bleeding.
Endometrial ablationis not suitable for women who desire amenorrhea for non-medical reasons because many women do not have amenorrhea after endometrial ablation, and some Research statistics suggest that the amenorrhea rate of patients receiving Nuoshu endometrial ablation is 30% to 75%, which means that there are still some women who only have reduced menstrual flow, and have not reached the level of complete menstruation.
What are the caveats?
First of all, it is necessary to understand some surgical contraindications. Endometrial ablation cannot be performed in the following situations.
Pregnancy.
Known or suspected endometrial hyperplasia or endometrial cancer. (Endometrial cancer requires surgery far more than endometrial removal)
Want to preserve fertility. (The elder sister in the article hopes that the operation can reduce the dilemma of the younger sister, but the operation may lead to the loss of the younger sister’s fertility. Whether the guardian has the right to make such a decision still needs legal or ethical professionals to decide.)
Active pelvic infection, surgery may lead to further spread of infection.
Have an intrauterine device and need to take the ring before surgery.
There is a weakening of the myometrium due to anatomical or pathological reasons, such as a history of classical cesarean section or transmural myomectomy; such procedures may cause myometrial degeneration Thin and may cause damage to adjacent internal organs (bladder, bowel) if the energy used for ablation passes through the uterine tissue.
▲Image source: Giphy
The most common recent complications of endometrial ablation are uterine perforation, bleeding, haemorrhage, and pelvic infection. The reason is that there may be adhesion of the endometrium after operation, leading to local blood accumulation, some of which are related to improper operation or individual factors that lead to unsatisfactory treatment effect.
There are two main types of long-term postoperative complications: recurrent yin tract bleeding and periodic pelvic pain, which may occur immediately or after surgery. appeared a few years later. The first reason may be that the endometrium was not completely removed during the operation, and the second reason may be the regeneration of the endometrium after surgery. Cyclic pelvic pain occurs months or years after surgery, and it may be caused by bleeding from the yin tract or blood in the uterine cavity or even the uterine horns.
Finally, to summarize, endometrial ablation is a minimally invasive surgery that uses radio frequency energy to destroy the endometrium. Medically, it is mainly used for menstruation caused by benign diseases. Too many women who also have no fertility requirements. Before the operation, the doctor needs to evaluate whether the specific condition of the patient’s uterine cavity is suitable for this technology, and the purpose of reducing menstrual flow and even menopause after the operation can be achieved.
In the story at the beginning of the article, the elder sister wants her sister to have surgery. From a medical point of view, there is no medical indication. In addition, as the guardian of the mentally handicapped disabled, do you have the right to represent the client? The decision to give up the right to reproduction still needs to be further discussed with legal professionals. Even if surgery can be performed, there may be inconsistencies with expectations, such as surgical complications, such as postoperative bleeding or pelvic pain, etc., which must be fully understood before surgery.
▲Image source: soogif
Special events, want to delay menstruation, what should I do?
Speaking of wanting to intervene in menstruation, many women may be more concerned about encountering some special events in life, such as exams, seaside vacations, and the need to postpone menstruation. What should they do?
These two most common methods of delaying menstruation are suggested: The first is to take a progestin, such as a progesterone capsule, starting a week before your period , until the end of the special event, the disadvantage of this method is that the effect is not necessarily reliable, that is, it may not be able to be delayed. The later the start time of taking it, the higher the failure rate.
Another method is oral contraceptives. In theory, menstruation will not occur while taking oral contraceptives. The disadvantage of this method is that some women are In the first cycle of taking the medicine, there will be a small amount of bleeding in the yin tract, which lasts for the entire period of taking the medicine. If you need to swim in the water, this method may not be suitable. It is best to adjust it through oral contraceptives in the previous menstrual cycle. period time.
The special structure of the female body creates a series of physiological responses. Menstruation may be a physiological phenomenon that every girl will experience, and we don’t need to change it for non-medical reasons.
If it is because of dysmenorrhea and physical discomfort caused by menstruation, it is recommended that girls go to the hospital for examination in time and improve it in the right way.
If you are really like the girl at the beginning and have all kinds of inconveniences in your life, I hope you can solve them in a more realistic and less harmful way.
Be sure to choose a surgical method to intervene in menstruation, and also carefully understand the surgical process, complications, precautions, etc., so as to be responsible for yourself.
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