Name of the Procedure:

Endometrial Cryoablation with Ultrasonic Guidance, Including Endometrial Curettage (when performed)

Summary

Endometrial cryoablation is a minimally invasive procedure used to treat heavy menstrual bleeding by freezing and destroying the lining of the uterus. The use of ultrasonic guidance enhances precision, and endometrial curettage (scraping of the uterine lining) may also be performed to prepare the uterus.

Purpose

This procedure addresses abnormal uterine bleeding (AUB) that does not respond well to medical treatments. The goal is to reduce or stop heavy menstrual bleeding by destroying the endometrial tissue responsible for the excessive bleeding.

Indications

• Heavy menstrual bleeding (menorrhagia)
• Irregular or prolonged menstrual periods
• Failure to respond to hormonal treatments or medications
• Anemia due to chronic blood loss

Preparation

• Fasting for 6-8 hours prior if sedation or anesthesia will be used.
• Discontinuing certain medications as advised by your doctor.
• A pre-procedural ultrasound or endometrial biopsy may be required for assessment.

Procedure Description

1. The patient is positioned on an exam table, and anesthesia or local sedation is administered.
2. A speculum is inserted into the vagina for access to the cervix.
3. A curette may be used to scrape the endometrial lining.
4. A cryoprobe, guided by ultrasound, is inserted into the uterus.
5. The probe releases cold temperatures to freeze and destroy the endometrial tissue.
6. The procedure typically lasts 15-30 minutes.
7. The instruments are removed, and the patient is monitored during recovery.

Duration

Approximately 15-30 minutes.

Setting

The procedure is typically performed in an outpatient clinic, surgical center, or hospital.

Personnel

• Gynecologist or surgeon
• Registered nurse
• Anesthesiologist (if sedation or anesthesia is used)
• Ultrasound technician

Risks and Complications

• Cramping or abdominal pain
• Infection or bleeding
• Injury to the uterus or surrounding organs
• Fluid buildup in the abdomen
• Rarely, thermal damage to nearby tissues

Benefits

• Reduction or cessation of heavy menstrual bleeding
• Improvement in quality of life and reduction in anemia-related symptoms
• Quick recovery time and minimally invasive

Recovery

• Mild cramping and watery discharge may occur for a few days.
• Avoid inserting anything into the vagina, such as tampons or engaging in sexual activity, for at least 2 weeks.
• Over-the-counter pain relievers can help manage discomfort.
• Follow-up with the doctor in 1-2 weeks to ensure proper healing.

Alternatives

• Hormonal treatments or medications
• Endometrial ablation using other energy sources (e.g., radiofrequency, thermal balloon)
• Hysterectomy (surgical removal of the uterus)
• Pros: less invasive than hysterectomy, minimal recovery time
• Cons: Not suitable for women who wish to become pregnant

Patient Experience

• Mild to moderate cramping during and after the procedure
• Sensation of cold from the cryoprobe
• Some patients might feel anxious but will be offered sedation or pain relief for comfort.
• Post-procedure: light bleeding and watery discharge are common for several days.