What do endometrial cryoblation and cryomyolysis have to offer?

March 1, 2005

As more patients with abnormal uterine bleeding look for alternatives to hysterectomy, drug therapy, and D&C, clinicians are turning to endometrial ablation to meet their needs. This brief overview takes a look at some of the advantages and disadvantages of cryoablation.

Menorrhagia is one of the most common gynecologic conditions affecting reproductive-aged women. Up to one in five women in this age group suffer from the problem, generating 2.7 million office visits in the United States each year.1 In addition, there are more than 650,000 hysterectomies performed each year in the US-nearly half of these patients have menorrhagia.

Physicians have recently rediscovered cryoablation as a simple, safe, and effective way to treat excessive uterine bleeding. The procedure involves freezing the endometrium under direct guidance of real-time ultrasound. In contrast to other approaches to endometrial ablation, cryoablation can usually be accomplished without cervical dilation and with little or no anesthesia.

Another appealing aspect of this procedure is its flexibility. Clinicians have more choice during the placement of the freezing probe, and more control over the duration of freezing. And it's this flexibility that makes cryoablation a viable option for a broad range of situations, including submucous myomas and irregular uterine cavities.

The usual options Traditional treatment options for patients with menorrhagia include drug therapy, dilatation and curettage, and hysterectomy. Each of these therapies, however, has significant limitations. Medical management is usually the first-line therapy and it typically consists of progestins or oral contraceptives. Yet over 65% of women in a recent survey said they wanted to avoid taking hormones.2 D&C is a useful diagnostic tool and may provide some relief, but the procedure usually only reduces bleeding temporarily.

As most ob/gyns know, hysterectomy is one of the most common procedures for managing menorrhagia; it's suitable for women who want to be sure that their bleeding is completely eliminated, or for women who have other gynecologic conditions that can also be resolved by removing the uterus. However, the rate of complications is high, and recovery time is significant. Many women prefer to reduce their bleeding in a less invasive way, and to maintain their organs.

Endometrial ablation, a relatively new treatment option that's quickly increasing in popularity, first gained attention with the development of hysteroscopic rollerball ablation. This procedure reduces or eliminates bleeding and is minimally invasive; the operative time is relatively short, and the recovery is usually rapid. Its limitations include the need for general anesthesia in most cases, risks associated with distension media, and a need for relatively advanced hysteroscopic skills.