Modified thermal balloon endometrial ablation for treatment of heavy menstrual bleeding

Abstract

Objectives: The objective of this study was to determine the efficacy of modified thermal balloon ablation using Foley's catheter in the treatment of heavy menstrual bleeding (HMB). Materials and Methods: Twelve patients with HMB aged 35–55 years underwent modified thermal balloon ablation using Foley's catheter. Patients were selected after complete clinical evaluation and investigations. The procedure was undertaken in the operation theater under general anesthesia/intravenous sedation. Three cycles of modified thermal balloon ablation using Foley's catheter were performed to ablate the endometrium. The time given to each cycle was 7 min. All the cycles were performed in the same setting. The main outcome measures that were studied were reduction in the menstrual flow, the need for further treatment, and relief of dysmenorrhea if present. Outcome measure regarding reduction in menstrual flow was statistically analyzed using Fisher's exact test. Statistical significance was determined at a level of P < 0.05. Results: Eighty-two percent of patients experienced a reasonable reduction in menstrual blood flow at 3-month follow-up. Eighteen percent observed no change in bleeding pattern and needed further treatment after failure of the procedure. Forty-two percent of patients complained of minor side effects such as cramp lower abdominal pain and fever. Rupture of balloon during the procedure occurred in only one case (8%). Conclusion: Modified thermal balloon ablation with Foley's catheter can be a promising management of HMB in resource-poor settings. It is a cost-effective alternative to the original endometrial ablation techniques.

"A Review of Dysmenorrhea and the Effectiveness of Varying Methods of Menstrual Relief"

“…Due to its analgesic benefits yet potential for side effects when consumed orally, researchers were prompted to develop a gel form of ibuprofen that could be administered trans dermally through the abdomen for uptake into the uterus, which was confirmed successful in female rats, signaling for possible promise in a transdermal analgesic for human treatment of dysmenorrhea [40]. Endometrial ablation is an existing procedure for the treatment of heavy menstrual bleeding, but a modification has been proposed using a modified Foley's catheter to perform thermal balloon ablation with the purpose of optimizing costs for treatment in settings with fewer resources [27]. Among the 12 subjects who underwent the procedure, nine reported a significant perceived decrease in menstrual bleeding [27].…”

“…Alternative nonpharmacological relief methods including herbal remedies and behavioral changes, and acupressure and acupuncture are also used, but research proving the effectiveness of these alternative therapies is limited when compared to that of pharmacologic therapies. Still, research has been done in observing effectiveness of novel or understudied treatment methods such as balloon endometrial ablation targeted to treat heavy menstrual bleeding and eastern or osteopathic medical treatments [1,27].…”

“…Endometrial ablation is an existing procedure for the treatment of heavy menstrual bleeding, but a modification has been proposed using a modified Foley's catheter to perform thermal balloon ablation with the purpose of optimizing costs for treatment in settings with fewer resources [27]. Among the 12 subjects who underwent the procedure, nine reported a significant perceived decrease in menstrual bleeding [27]. The study is limited, though, with a small sample size of only 12 and lack of ability to set and monitor temperature and pressure during the procedure.…”