Existing solutions for pre-menopausal bleeding besides hysterectomy

Hysterectomy is one of the most common gynecological surgeries today. In recent years alternative treatments to hysterectomy have been developed. These treatments are currently used as a first line of treatment before deciding on hysterectomy. Since only the endometrium rather than the whole uterus is involved in the bleeding, methods have been developed that address the endometrium only. Each patient should discuss with their attending physician about the best treatment approach for her. Alternative methods include:

Medication - giving hormones to restore the hormonal balance. This treatment is common for women who wish to remain fertile, and effective in reducing bleeding without requiring surgery. The drugs should be taken over time. There may be minor side effects such as headaches, tender breasts and weight gain. The effectiveness of the medication is relatively limited.

Curettage - this was accepted as the first surgical treatment offered to women who have not responded to medication. This treatment involves mechanical scraping of the lining of the uterus under general anesthesia. It is still used in cases of severe bleeding that requires immediate treatment until the definitive treatment is performed.

Hormonal progesterone coated IUD (Mirena) - This is a contraceptive means and suitable for patients of childbearing age. The Mirena device continuously releases progesterone in a continuous and controlled manner directly to the lining of the uterus. The progesterone prevents the uterine lining from growing and helps in reducing bleeding in a high percentage of women.

Hysteroscopy methods - this is a surgical procedure which is performed by burning the endometrium with an electrosurgical device; hysteroscopy allows observation of the uterine cavity by inserting a thin optical fiber into the uterus. The lining is removed under continuous observation using a loop or heated roller. This method is suitable even when there is a finding such as an intrauterine polyp in the space which should be removed. The procedure is done under general anesthesia and requires a high level of medical skill. The success rate stands at 85%, and risks of the procedure may be perforation of the uterine wall, bleeding and infections.

Non-hysteroscopy methods - theseuse different energy sources (heat, microwave, laser, etc.) in order to remove the uterine lining.

Endometrial destruction using the thermal balloon, Thermachoice- The Gynecology Department at Hadassah Hospital has for the last five years been performing an innovative treatment to reduce limited or irregular menstrual bleeding designed for women with a normal uterine cavity from an anatomical perspective, after their planned hildbearing years. This treatment is done using a device called Thermachoice designed for the treatment of the mucosal layer of the uterus only, using heat. First, a soft and flexible balloon attached to a thin tube is introduced into the uterus through the vagina. The balloon is then inflated with sterile fluid to fit the size and shape of the uterus. The fluid in the balloon is heated for eight minutes of treatment in a computer-controlled manner, during which the endometrium layer of the uterus is destroyed.

After the procedure, the treated uterine lining sheds for about 7 to 10 days, similarly to a menstrual period (secretions, bleeding), but without the ability to regenerate in most cases. The treatment can be performed under local or general anesthetic. Medication against pain and uterine contractions will be given following the procedure. In the majority of cases, menstrual bleeding disappears or significantly diminishes. Most women return to regular activities within a few days.

The treatment is suitable only for women who do not want to give birth anymore in the future, and is not used as a contraceptive measure. In rare cases a woman can become pregnant after this treatment, so contraception should be used.