Cryoablation

Icy therapy for uterine bleeding

For some women, a quick office procedure may be all it takes to stop abnormal uterine bleeding. That procedure is cryoablation, a technique that uses liquid nitrogen to freeze the inner lining of the uterus to stop chronic bleeding in women for whom other treatments haven’t worked and who don’t want hysterectomies. “It’s a great procedure for select people who want to retain their uterus, or don’t want a big abdominal surgery,” says Dr. Pinar Kodaman, one of Yale’s cryoablation specialists.

Many other ablation techniques involve heating the uterine lining, or endometrium; they often require general or spinal anesthesia. But in cryoablation, the cold itself serves as anesthesia.

The procedure takes about fifteen minutes. The patient is given local anesthesia at the cervix, then the doctor inserts a slender liquid nitrogen probe which touches the inner uterus and forms an “iceball.” An assistant uses ultrasound to help the doctor direct the probe accurately and freeze just enough tissue. The patient goes home shortly afterward, and generally needs only ibuprofen for discomfort.

After cryoablation, about 90% of women report an improvement in their bleeding, though about two-thirds continue to have periods. Women who want their periods to stop altogether, Dr. Kodaman says, should consider getting a hysterectomy.

She cautions that while it is still possible to get pregnant after cryoablation, it is very unsafe to do so, and women considering the procedure should have completed childbearing. “They should always have a good form of contraception,” she says.