One in four women at some point their during reproductive life suffers from heavy menses significantly impacting quality of life. This can be determined in the medical sense, if the patient has anemia or has failed medical management, or may be self determined. If there is any limit in daily activities associated with menses, certainly some intervention is indicated. On occasion, heavy menses may also be associated with significant pain and premenstrual symptoms (PMS).

Solutions to date have included hysterectomy. This surgery eliminates menstrual flow, menstrual cramping, and most often significantly decreases premenstrual symptoms. Medical management, in order to avoid surgical intervention, may include oral contraceptives for those patients that have no contraindications, cyclic progestins often with side effects, or potentially use of a 5 year duration progesterone-only IUD. This may be redundant if a patient has previously undergone tubal sterilization or her partner has had vasectomy.

A newer, less invasive surgical option over the past 10-15 years has been endometrial ablation. This is either by direct visualization inside the uterus or indirect treatment attempting to destroy the lining of the uterine cavity. This decreases menstrual flow and most methods significantly improve menstrual cramping and premenstrual symptoms. Until recently however, almost all of these procedures have required significant anesthesia because of the discomfort associated, and require at least an outpatient surgery setting, or hospital setting. Fortunately, there is now an FDA approved ablation device for in office use.

This procedure is called Her Option. It is a "freeze" technique, therefore automatically providing some degree of anesthesia. Success rates in studies lasting over two years have shown at least a 90% satisfaction rate, with significant decrease in menstrual flow, menstrual cramping, and premenstrual symptoms. Because this device uses a "freeze ball" in the uterine cavity, it has also successfully treated limited fibroids within the uterine cavity, or those at least close to the cavity contributing to heavy menses.

Her Option is intended only for patients who do not wish to have any further pregnancies; reliable contraception should already be in use and continued. Some patients will not be candidates. Poor candidates are patients with larger uterine size and significant fibroids. Endometriosis will not respond to this treatment. Women with unexplained abnormal uterine bleeding and post menopausal patients with abnormal changes in the lining of the uterus are not candidates. Some testing may be required to determine if the procedure is appropriate.

There may be some preparation of the lining of the uterus involved prior to the procedure. The patient may need an ultrasound, or an endometrial biopsy before Her Option is performed. Usually a patient is provided a sedative orally, and given a local anesthetic. The treatment is used with ultrasound guidance, to localize the probe and follow the expansion of the "freeze ball". Within the first 3-6 months following the procedure, a "new" menstrual pattern is likely to be established. The goal is actually to have "normal" menses or less. Amenorrhea (no menses) rates however approach 30-40%.This procedure is very well tolerated, and is quite cost-effective, with most insurance companies requiring only in office co-pay.

As with any procedure, there are risks associated, such as injury to the uterus. Ultrasound guidance with this procedure significantly decreases that risk. There may be slight flushing after the procedure, with some nausea, but this is very short-lived. If the procedure fails, this usually becomes evident within the first two years. Some patients may not be comfortable with simply a goal of "normal" periods, and prefer definitive treatment, a hysterectomy. However, for those patients with busy schedules, unable to obligate an entire day for any type of outpatient surgery and anesthetic recovery, and desiring to avoid the significant costs associated with hospital treatment, Her Option
should seriously be considered. Further information is available
at the Her Option website (www.heroption.com) as well as
Washington Women's Care.

(252) 946-6544 • 1-800-675-5694