Experts estimate that 20 percent of women experience excessive or prolonged menstrual bleeding at some time during their lives, particularly as they approach menopause. A new, less invasive procedure called global endometrial ablation (GEA) preserves the uterus, while decreasing menstrual bleeding and shortening patients’ recovery time. In an article published in the January issue of Obstetrics and Gynecology, Mayo Clinic researchers attempt to determine the percentage of women who do not achieve permanent symptom relief from GEA and identify several factors that put women at greater risk for this outcome.
For decades, hormone pills or hysterectomy, surgical removal of the uterus, were the standard treatments for excessive or prolonged menstrual bleeding. Although numerous studies have established the safety of GEA, some women who undergo this procedure require additional treatment or hysterectomy later because significant menstrual pain or heavy bleeding symptoms resume.
During this procedure, surgeons use an energy source (heat, cold and microwave or radiofrequency energy) to destroy just the uterine lining (endometrium) and leave the uterus intact. Once the cells or the tissue that line the uterus are destroyed, scar tissue forms, and monthly menstrual flow and any accompanying pain typically decrease.
Compared to hysterectomy, the newest forms of GEA were initially thought to be equally effective, with slightly lower complication rates and costs.
“We’ve known for the past five to six years that global endometrial ablation devices are very effective,” says Mayo Clinic gynecologic surgeon Abimbola Famuyide, M.B.B.S., one of the study’s authors. “But some physicians have observed that up to 30 percent of patients may require additional treatment five years and beyond after undergoing ablation.”
According to the Mayo researchers, identifying risk factors that affect treatment outcomes following GEA is an important advance in this field. This knowledge can help surgeons determine whether GEA is appropriate for a specific patient and help them provide patients with better guidance when choosing a treatment option, say researchers.
“Optimizing preoperative patient counseling and patient selection could allow failure rates associated with GEA to decrease,” explains Dr. Famuyide.
Below is a link to an edited a youtube video with Dr. Famuyide.
I had an ablation to treat heavy bleeding (ongoing for a year) for heavy bleeding. At the same time removal of a chocolate ovarian cyst and removal of one overy. My bleeding is greatly reduced but it is nine weeks later and I am still bleeding. Doctor gave me antibiotics for a week. Bleeding stopped for 3 days then resumed. Now Doc. is on vacation nurse says wait a week and call back if still bleeding. Is this normal? Thanks for any input.
Depending on your definition of “heavy menstrual bleeding” I think one could say that nearly 80% of women actually suffer from this. It is all too common. Most of my friends complain at least part of the time that their periods keep them from doing things they like to do – or are we talking close-to-death type bleeding here?
Menstrual Cramp Remedies
Hello Jeanie,
I’ve passed your question on to Dr. Famuyide’s office. Thanks for your time.
Amy
I had an endometrial ablation on March 13, 2009. After a week I stopped all bleeding. All of the sudden yesterday I had light bleeding, less that 24 hours now, it is very heavy and with clots. My on call nurse for my doctor said to that it is fine as long as I don’t soak through a pad in one hour. I am very close to it. I know some people resume their periods, but this doesn’t seem like a regular period. By they way before March I had heavy bleeding every single day for 8 years non stop. No breaks not even one day. I have had 4 blood transfusions and am anemic and even have hair loss. I have PCOS also. What can I do? What is going on? Why did the bleeding start again? Is this normal?
It is good that you are in contact with your local health care provider in this situation. Thanks for your questions. I am passing them along to Dr. Famuyide’s office.
Did this ever stop? I had the same thing happen 10 days after my novasure. I had to have a blood transfusion. I was passing clots 2 fists size.
I had it done on 3-20-09 and I did fine two weeks after. Just some discharge. Then in the 3rd week I was bleeding all over the place, we had to buy pads to go under me so I would not bleed thru the sheets. I was wearing 2 overnight pads and changing them every hour an a half. My husband call the dr. because we were at the table and my back started to hurt really bad, so I got up from the table and felt some thing guss in my underwear. I went to the rest room and I had a clot come out of me that was the size of my hand, it felt like jello coming out. The nurse said that was ok, as long as I was not feeling a pad in an hour. But I was and we told her that I had to start throwing away my sweat pants becuase I was soaking thru them. The dr said that some times after the surgery becuase of the meds they use to put you to sleep that you can have a reall hard peorid and it can take up to 6 mts for your peorids to stop. I did not know that and I am just braceing my self for the next one, they are worst then before I had this done.
Ok I have written before. I had an endometrial ablation on March 20th and started bleeding heavily again. My doctor performed a second endometrial ablation on May 11th and all went well until a few days ago.My bleeding is back AGAIN!!! He told me that after 2nd ablations there would most likely be no bleeding not even periods yet here I am again. I dont know what to do. After my 2nd ablation he said if it happened again I would have to have a hysterectomy. Im 32 and don’t want to do that. Is there anything else I can do?
I had my ablation January 2009. I had no bleeding until July 11 with pain so bad I had to go to the ER. I was not given a choice of another ablation and have decided to have a hysterectomy. I am 51 and I feel I have tried everything I can to stop the heavy bleeding.
Individual results for any given procedure will vary based on the patient’s individual circumstances. If you would like to seek an appointment to be seen at Mayo Clinic to review options, you may call 507-266-8680 to request an appointment.
I had my Endometrial Ablation done in Nov. of 2007. Yesturday 1-9-10 I started feeling sick and then all period symptoms started. Then i started to spot a very brown bloody show. Today 1-10-10 my symptoms are worse cramps almost unbareable and now i have a bright red bloody show. I need to know if this is normal? I’m going to call my doctor in the morning to get an appointment to find out.
It’s good that you plan to contact your health care provider in the morning. However, if you think your situation needs urgent attention, call 911.
I had endometrial ablation done in October, 2003, for extremely heavy bleeding leading to anemia and extremely low feritin levels. After the ablation I rarely ever bled and if I did it was only a spot. It was wonderful!
In September, 2009, I experienced extreme lower abdominal pain and was taken to the ER. It was determined that there was a great deal of fluid in my uterus that wasn’t draining, and my uterus was fairly enlarged. The following day, my gyne did a D&C removing a great deal of the old material. The reason the old material didn’t drain was because scar tissue had formed in the opening between the uterus and the cervix. After all this time, it appears that my bleeding problems have returned – some times I will go through 2-3 overnight pads in 1 hour. The bleeding is unpredictable. In addition, my gyne has had to open the cervix a few more times. Taking birth control pills has helped reduce the bleeding, but they have greatly increased my migraines.
Am I a candidate for another EA? I am 51.
Thank you. We will email you with a reply.
well i have had an endometrial ablation on 4-30-10 i started bleeding on 5-9-10 and it is the 18 nd i am still bleeding the periods are light.but i got the surgery done because i was having long periods bleeding for 20 to 30 days i never had heavy bleeding and known i am still bleeding longer then i should i go see the doc on the 20 of this month i will see what they say but i feel like i should have not got this done because i have pain in the stomach i never had cramps before but known i do not everyday but every other day.
I am 51 and I had a hydrothermal ablation in 2007. After the ablation, I did have regular menses, but at a vastly decreased rate, so they were manageable. The menses continued until late 2009, then stopped. I still often had the monthly mentstrual “symptoms” (i.e. sore breasts, water weight gain, migraines, appetite variance, emotional issues), but there was no flow. I did experience the weight gain that many other women experience as a result of the procedure – not a happy thing for an aLready obese woman struggling with losing weight.
At the same time, I began to experience what I believed were menopausal symptoms. My internal temperature regulation was off, I was experiencing what I call my “personal summers”, and I had night sweats (not debilitating, just annoying). My conclusion? I was menopausal.
Now it is May of 2011, and I am experiencing a menstruation that reminds me very much of my former cycles. I have had extremely painful cramping for three days, along with weight gain, breast tenderness, migraines, nausea and a ravenous appetite. But the most surprising of all symptoms is the heaviness of the flow – it is approaching what my regular menses, prior to those that indicated that an ablation might be needed, were like. (In those days, I menstruated for about 10 days, with heavy flow for about 5 – 7 of those.)
Is this resumption of menses something that is common with those my age who have had HTA? Should I contact my OB/GYN immediately, or should I wait until next month to see if the cycle continues?
Hi Anette, We have received your question, and unfortunately, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence. If you would like to seek help from Mayo Clinic, please call one of our appointment offices listed at this site: http://www.mayoclinic.org/patientinfo/appointments.html.
I am 32. I have a history of heavy bleeding and clotting that was so severe that I have had over 20 blood transfusions. I had the Novasure procedure done in February of 2010. It worked somewhat for about 7 months and then the heavy bleeding and clotting returned (bleeding non stop, soaking through super plus tampon and overnight pad every 45-60 minutes). My doctor recommended that I try another ablation. This time she performed the thermal balloon ablation on 05/24/2011. I was awake for this procedure and I am not sure the doctor really knew what she was doing as another doctor was there coaching her and telling her what to do and they had to keep repeating filling the balloon and draining it, they repeated that part 6 times before they heated the liquid. I had bleeding that day as expected and then only clear pinkish fluid for a week and a half. Now, less than 2 weeks since I had the procedure I am bleeding and clotting very heavily again and beyond frustrated. Is this normal? My own doctor gave me no post procedure expectations and I am more confused than ever. Does it sometimes take weeks or months before the scarring takes place and the bleeding slows down? Should a D&C have been performed first to thin the lining? I was told that it was thick by the sonographer. Thanks for any help you can give me.
Jill, We have received your question, and unfortunately, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence. If you would like to seek help from Mayo Clinic, please call one of our appointment offices listed at this site: http://www.mayoclinic.org/patientinfo/appointments.html.
Jillann, We have received your question and unfortunately, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence. If you would like to seek help from Mayo Clinic, please call one of our appointment offices found at this link: http://www.mayoclinic.org/patientinfo/appointments.html
I had the Novasure procedure done in April and initially had very light periods. Now, about 4 months later, I have had heavy bleeding (through 4 pads this morning) like I had before the proceedure was completed. Is this normal? Do I need to give it more time or should I be concerned?
Unfortunately, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence. If you would like to seek help from Mayo Clinic, please call one of our appointment offices. The numbers can be found here: http://www.mayoclinic.org/patientinfo/appointments.html
I had an ablasion back in April 2009 and have not had any problems but I was told years ago I had PCOS. I was wondering if that goes away once you have ablasion or if I could still have it. I am having a very difficult time losing any weight and have wiskers growing on my chin. I was on metaformin for a while but when I went to a different Specialists for the heavy bleeding he dismissed the pcos.
Thanks for your interest, Julie. Unfortunately, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations here. If you would like to seek help from Mayo Clinic, please call our appointment office in Arizona at 480-301-1735; Florida, 904-953-0323; or Minnesota, 507-284-2511.
I had an ablation 3 years ago. A year after my period returned and was very light. About 2 nonths ago I began spotting for weeks and it seems as though the periods have stopped with just spotting. Worried it could be more than a failed ablation.
I had an ablation almost 4 years ago and as of recently my bleeding has been getting heavier and heavier again and it is coming more frequently with bad cramps . Is it possible that I could need another one . Has that happened before with any other ablations ?
Thank you
Lori
Lori, we have referred your comment on for answering.
I had the Novasure Ablation in Sept 2010, at the age of 46. No medical issues at all, except for heavy, long lasting periods. I bled/had a discharge, requiring a pantyliner, every single day, and had a backache, and pain in my tailbone, for 4 months straight, until my GYN put me on hormone therapy for 30 days. 30 days estrogen plus 14 days of progesterone the second half of the month. The bleeding stopped after that, but as of 7 days ago, a year since the procedure, I have started bleeding, again, nonstop, and having cramps, pressure, bloating, and a dull burning ache in my right side, requiring using something beyond a pantyliner.
Had I known what “could” happen, or that it could fail, I would not have chosen to have the Novasure Ablation procedure done. PLEASE, check all the facts, and read as many message boards as you can before going ahead with this procedure.
Good Day: I will be 52 this year and have not had any serious issues with health or weight. However I did need the ablation which I had done approximately 4 years ago with great results. My extreme periods were now very light and still like clockwork I have my periods every month, normally 26 days apart…..until Jan 18.
I have now started my period but unlike the 2 1/2 day period I was having it’s very heavy and doesn’t seem like it will stop. I will call my doctor on Monday, however I have heard of the excellent results from your clinic and was wondering if you could offer some advise. Thank you.
Elizabeth,
Thanks for your comment. While we can’t provide specific medical advice through this venue, I will forward your comments on to an appropriate person for a possible reply.
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I had my ablation done on 4-25-12 everything seemed fine until 5-2 and my husband had to take me to the ER in severe pain after doing a CAT scan they found I had a kidney blockage, the next week (5-10)I had surgery to remove the blockage and open the ureter only to find it wasn’t blocked internally. Then on 5-18 I had yet another surgery to remove the blockage the surgeon found that the scar tissue had left my uterus and attached itself around my ureter.
I had my endometrial ablation 2/3/12. Ten days later I started bleeding lightly, this lasted for 29 days (only used a pad a day). Then I had what I thought was a “normal” light period for 7 days. Then another 7 days later I started again and bled for 17 days, stopped for another week and now I am bleeding again (heavier this time) It’s not horrible bleeding but I have used 2 tampons and a pad today and I’m passing blood clots again. I have cramps, upset stomach the whole nine yards. I am getting frustrated because I didn’t even want this surgery to begin with and now I may need another surgery.
Btw…my doctor keeps telling me to wait another month each time I see him and wants me to take megace daily but megace makes my blood pressure and blood sugar high.
In 2006 I was diagnosed with a seizure disorder and put on anti-seizure medication. The seizure meds interfered with my birth control. I became pregnant and had a baby girl in October 2007.An ablation was considered the best option for me because then I wouldn’t have to worry about anymore drug interactions.The ablation was in 2008. I have been period free for years,now all of the sudden I’m having a period again. What’s up with this?
Angie, we cannot diagnose conditions, provide second opinions or make specific treatment recommendations through this correspondence. If you would like to seek help from Mayo Clinic, please call one of our appointment offices. The numbers can be found at http://www.mayoclinic.org/ under “request an appointment.”
Anyone have POSITIVE results with the NovaSure Enometrial Ablation?
We are checking on this for you.
We’re not sure what you mean by “positive” results…but, ~95% of well selected patients state they are satisfied with NovaSure endometrial ablation or any ablation therapy for menorrhagia. This often means an average of 90% reduction in menstrual blood flow. On average, nearly half would report complete cessation of menses, although that figure varies with age at the time of ablation, size of the uterus and the type of ablation technology. 5 years out from ablation, nearly 1 in 5 women will require additional therapies for heavy menstrual bleeding or pain, although 4 out of 5 will remain satisfied.