In-Depth: Endometrial Ablation w/ Dr. Barbara Levy | BackTable OBGYN Podcast Ep. 37

This week on BackTable OBGYN, Drs. Mark Hoffman and Amy Park are joined by Dr. Barbara Levy to discuss the latest advancements in endometrial ablation using cryotherapy. Dr. Levy, a professor at George Washington University and a volunteer at the University of California San Diego OBGYN and reproductive sciences department, has dedicated her career to gynecological advancements.

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SHOW NOTES

Initially, the physicians delve into the history of endometrial ablation, originally conceived as an alternative to hysterectomy for severe menstrual bleeding. The early method involved using a fiber to ablate the entire cavity, followed by electrosurgery using a roller ball, which has various control-related challenges. This approach necessitates operating room time, anesthesia, and prolonged recovery with significant pain. As techniques advanced, complications, including burns and bowel injuries, emerged. The introduction of cryotherapy marked a significant breakthrough in ablation. However, it initially had a steep learning curve.

Barbara then details the new Cerene handheld cryoablation device, highlighting its advantages over traditional rollerball electrocautery. The primary benefit of cryotherapy is the improved healing pattern of the uterus compared to electrocautery. Electrocautery often results in Asherman's syndrome, leading to scarring and adhesions, making visualizing the uterine cavity for concern of future pathologies very difficult. Cryotherapy offers over 90% visibility into the cavity, making assessment for uterine or endometrial cancer much easier.

Barbara emphasizes that cryotherapy minimizes or avoids complications such as abnormal vaginal discharge, prolapsed fibroids, dyspareunia, persistent bleeding, and post-ablation pain syndrome when compared to heat-based methods.She outlines various patient-centric advantages, notably in pain management. Cryotherapy numbs nerves before ablation, allowing in-office procedures without sedation or anesthesia. Patients can tolerate the procedure well, typically requiring only NSAIDs for comfort during device insertion through the cervix. The accessibility of this procedure through telehealth and brief in-office appointments reduces the impact on patients' daily lives and costs, eliminating the need for operating room time and anesthesia. Instead, patients only pay a copay in the office.

Barbara highlights specific patient populations that can benefit from this therapy, including those with heavy menorrhea leading to iron deficiency anemia. It is also suitable for women unable to use additional hormones due to breast cancer concerns or those who prefer not have an IUD but suffer from heavy menorrhea. Patients facing barriers to healthcare, such as those in rural areas, those with time constraints due to work, or financial constraints, may significantly improve their quality of life. Additionally, women in their forties, no longer in their childbearing years, with heavy periods and an alternate form of long-term contraception, can particularly benefit from this therapy.

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