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Non surgical treatment of heavy periods
- 2. Dysfunctional uterine bleeding as we all understand is an abnormal uterine bleeding from the genital tract in the absence of an organic disease or clinically detectable lesion. Such bleeding is most often due to endocrine dysfunction that inhibits normal ovulation Treatment Includes- Medical Therapy - Surgical Therapy
- 3. •Quite Effective •Loses It’s effectivity with time •60% of women need to undergo hysterectomy with in 5 years.
- 4. .Indicated once medical therapy fails or patient unwilling to continue a long term medical treatment .D&C .Endometrial ablative techniques .Hystrectomy
- 5. •Computerized device consists of balloon catheter and controller •Uses Thermal energy to ablate the endometrial lining with a treatment cycle of 8 mins.
- 6. •Age 30 - 50 years •Completed child bearing •Uterine cavity depth 4 - 12 cms. •No endometrial pre/malignant lesion •Normal pap smear •No adnexal masses •No uterine fibroids or polyps •No bleeding disorders •No Hypothyroidism
- 7. •Lithotomy position •I.V. sedation (+/- paracervical block) •D&C •Soft flexible catheter with balloon introduced through the cervix •Balloon inflated with D5% sol.to a pressure of 160-180 mm Hg •Heating element inside the balloon activated to achieve a temp. of 87°C or 188°F for 8 mins. Thereafter fluid is drained and catheder removed
- 8. *The Depth of endometrium following D&C or Danazol treatment is 3-4 mm *Mean extent of damage to endomyometrium using U.B.T is 5.4 mm thereby destroying the endometrial lining completely
- 9. *Cramps / pelvic pain Rx N.S.A.I.D.S. *Nausea/Vomitting –24% cases *Endometritis -2% cases Rx Routine Antibiotics *Haematometra - 0.6% cases Rx Sounding
- 10. •Out Patient Procedure (4-6 hrs) •No Anaesthesia, No Skin incision, No scar •Good Alternative to hysterectomy •Patient returns to work after a days rest •Ideal for patients unwilling or unfit for surgery & Anaesthiesia (cardiac disease / uncontrolled diabetes/renal disease) •Patients too young to undergo a hysterectomy •Minimal learning curve
- 11. •Age <30 yrs •Desirous of child bearing •Uterine cavity >12 cms. •Uterine cavity <4 cms. •Uterine fibroids / polyps •Known/suspected endometrial CA •Abnormal shape of uterus •Weakening of myometrium eg. Prev. classical CS or Transmural myomectomy •History Of latex allergy •Active Genital Tuberculosis •Active UTI/PID •IUCD in vivo •Failure Of Prev. Ablative procedure
- 12. •We have done 8 cases out of which 6 patients were highly satisfied and two were not benefited. •All patients were subjected to a pre-procedure D&C. •The H.P.E. was prolif. Endo. in 4 patients,irregular Endo. in 3 patients and simple hyperplasia in 1 pt. •The detail is as follows
- 13. 1. K.R 47/P5+2 Obesity (104Kg) Not Satisfied I.H.D (EF 50%) Menst. Pattern DM 10yrs unchanged. 2. S.J. 30/P2+0 Not keen for Highly Satisfied surgery Initial amen.(3m) Now scanty pds. 3. K.J. 48/P2+2 Ch.Renal Dis. Highly Satisfied Uncont. HTN Complete amen. 4. M.K. 36/P3+0 Not Keen for Satisfied surgery Regular pds. Eumenorrhoea
- 14. 5. D.K. 42/P4+0 Uncontrolled Satisfied. amen. HTN till date 6. N.K. 33/P2+1 Not willing for Highly satisfied major surg. Scanty pds. (1-2 days) . S.k. 40/P3+3 C.O.A.D Severely Highly satisfied restricted resp. Reg.scanty pds. functions . N.B. 46/P6+2 H/O Jaundice Not satisfied. 6 weeks ago Pds.same as before.
- 15. * Thermachoice U.B.T is a very effective alternative to hysterectomy * Very short procedure.(30 mins.) * Day care procedure. * No Anaesthesia. * No mortality. * No morbidity except vaginal discharge. * No post-operative complications. * Extremely safe procedure. * Extremely Successful with a satisfaction rate of 88-91% (Br.J. Ob.Gy. 98)