- Uterus Conserving Surgeries for Dub (Endometrial Ablatio /Resection)
The various surgeries are:
- Transcervical resection of endometrium (TCRE),in which the basal endometrium is removed using diathermy loop
- Roller ball endometrial ablation
- Laser (Nd: YAG) endometrial ablation
- MEA (microwave of 9.2 GHz used for endometrial ablation)
- Uterine thermal balloon in which hot saline/ dextrose is circulated within the balloon after it is placed inside the uterus
- Hydrothermal ablator in which heated saline in circulated within uterine cavity
In a D/C, only superficial endometrium is removed which grows back, but in above minimally invasive surgeries the basal endometrium IS destroyed so that it does not regenerate back.
- Patient's family should be complete
- Histopathology: there should be no evidence of malignancy
- Day care procedure
- Major surgery such as hysterotomy is avoided
- 40% patients will become amenorrheic.
- 40% will have hypomenorrhea.
- Only 20% will require hysterectomy.
- Simple Hystectomy (Abdominal / Vaginal - NDVH/ Laparoscopic)
Metropathia Hemorrhagica (Schroeder's Disease/Cystic Glandular Hyperplasia)
- This is usually seen in perimenopausal women due to infrequent/Irregular ovulation.
- The classical presenting feature is amenorrhea followed by menorrhagia.
- As there is no ovulation, there is unopposed estrogenic action on the endometrium leading to thickening of endometrium and a period of amenorrhea.
- After a variable period of time (6-8 weeks), the endometrial shedding happens (either due to decrease in estrogen or when the endometrium outgrows it blood supply), resulting in heavy bleeding.
- There is myohyperplasia, and there can be symmetric enlargement of uterus to about 8-10 weeks size and the endometrium looks thick, congested, and polypoidal.
- Histopathology: cystic glandular hyperplasia, Swiss cheese pattern (small and large empty glands with columnar epithelium), and absence of secretory changes.
- Swiss cheese pattern is also seen on ultrasonography in adenomyosis.