Endometrial Ablation Needed?

[ttom]

I am 42 years old.  Beginning in Jan. '07, I started having extremely heavy mentual bleeding with blood clots.  With my next period in March, I saw my doctor, who prescribed Progrestin after 2 weeks of heavy bleeding.  From Ultrasounds, she determined I have a uterine polyp, about 8mm, and had a small cyst on one ovary.  The cyst was gone in July '07 in a subsequent Ultrsound.  The passing of blood clots has lessened, but I still have frequent spotting.  I have also started exercising 3 times per week, which seems to increase the spotting.  The doctor would like to do a Hysteroscopy and D&C to remove the polyp.  She also recommends an Endometrial Ablation since I am finished having children.  Do you think I should proceed with the Hysteroscopy & D&C?  OR is there anything that I can do to help the polyp resolve itself? Do you think the Ablation is necessary if I have the other surgery done?
Thank you for your advice.

[Machelle Seibel, MD]

For women with a uterine polyp, it is important to have the polyp removed. Although it can be done with a D&C which scrapes the lining, that is a "blind" procedure as the doctor can't see inside the uterus when the surgery is going on. Hysteroscopy uses a telescope that allows the gyn to actually see and remove more precisely the polyp, or to see if there is more than one. It is a relatively minor procedure. Usually a D&C is done afterward. Polyps almost never go away unless they are removed.

Doing an ablation at age 42 after one episode of bleeding is a consideration but certainly not doing one is also a consideration. Many times removing a polyp and exercising will stop the extra bleeding and doing the ablation won't be necessary. Most ablations will miss at least some portion of the uterine lining so the detection of uterine cancer can in theory be made more difficult. Ablations are relatively new  procedures so actual impact on uterine cancer are still being determined. Having good anesthesia even for the hysteroscopy is important. It doesn't have to be regional (ie a spinal or epidural). Many can be done with sedation or so called twilight anesthesia. Some people start that way and arrange to switch to general if they feel uncomfortable during the procedure. If the ablation is done, most would want general anesthesia.
Machelle M. Seibel, MD

[ttom]

Also, I failed to mention I am concerned about the risks related to the ablation.  Can you tell me your thoughts about the inability to detect uterine cancer after an ablation and other risks?  Also,  can other polyps grow after the ablation?  
I am also wondering about the type of anesthesia to be used.  The doctor would be performing the surgery in an Outpatient Facility (not her office). The doctor said it would be general anesthesia (due to expected cramping) that I recover from in about one hour.  Is the general anesthesia necessary if I do not have the Ablation performed?  I am concerned about the risks/side effects of the anesthesia.  She said the recovery time for a regional anesthesia is significantly longer and therefore, not used.
Thank you for your help.