Is an Endometrial Ablation the Safe Answer?

Hi, I'm Dr. Tabitha, the gutsy gynecologist. I'm a triple board certified, OB, GYN and Functional Medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey. And I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyne health and your overall health. And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more band aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome. This week I am answering your question about endometrial ablation. Okay. I have had so many of you reach out to me and say, my doctor recommends an endometrial ablation, or I'm thinking about getting an endometrial ablation. What do you think? Is this a safe procedure? Should I do this? And there's so much to unpack here. It's like such a super important conversation because the CDC is now saying that the endometrial ablation is a $3.2 billion industry. You guys, that is just one treatment for heavy periods out of many treatments. And that is already a billion dollar industry. The CDC is projecting that it's going to increase to $5.4 billion by 2028. So have no doubt, medicine is big business. Medicine is making people a lot of money. So what we need to figure out is, is it right for you? Because it doesn't matter what the medical establishment recommends. It matters what's going on with you individually. Right? So I want to have just a frank discussion about what is happening. So here's the deal. About 10 million American women, just American, are affected by heavy periods every year. That's a lot of us, right? Heavy periods really can interfere with our life. They not only make us feel exhausted, they prevent us from going to work or to school. They prevent us from being intimate with our partners. They ruin our clothes, they ruin social situations for us. And it costs a lot of money for all of those personal care products. You know, whether you're using a diva cup or tampons or pads, hopefully they're organic. If you're using those, because traditional ones are full of toxins. That's a side note, but it's expensive to have periods, let alone heavy periods, right? And so we're always looking for a new way to get rid of periods. What's the quick fix? And so when I was in residency, endometrial ablation was all the rage. And essentially, the idea behind an endometrial ablation is that we are burning the lining inside the uterus, the lining that is supposed to grow in response to estrogen every month, and that stays around and stays plush with the help of progesterone in the event that you fertilize your egg and it needs to implant into the uterus to carry a pregnancy. So that is what your body is trying to do every month. Every month it thinks you're potentially going to get pregnant. So let's make a nice, cush, perfect environment inside the uterus for that egg to implant and start to grow into a fetus. So the lining is called the endometrium, or the endometrial lining. And that is what bleeds and sheds and releases for your period every month. And the idea behind the ablation is to burn that lining so that it cannot grow. Every month, it kind of scars it down to the myometrium, the muscle layer of the uterus. And so if that area is scarred, it will no longer grow. And the idea, you know, seemed great when it first came out. It was like, oh, we'll just burn that lining. It will no longer grow. It will no longer respond to hormones, and women won't have any periods. But our bodies have this amazing innate intelligence to repair and regenerate. And so what happens a lot of the time is that your body overcomes that burn or that scar, and it starts growing your endometrial lining again. The biggest problem is that sometimes it grows it in patches and not uniformly throughout the whole cavity of the uterus. So you can get a patch here or there that is growing better than another patch. Another patch might be more scarred. And on top of it, our uterus is a potential space. It's a cavity. So think of a balloon. When the balloon is not filled up, it's lying flat, and the sides of the balloon are touching each other, right? They are connected. It's not until you put air in the balloon and separate those walls that you create that potential space, that cavity inside the balloon. And that's what happens with the uterus. So the uterus walls collapse on each other, and they kind of stick together. And so you can imagine after an ablation, during that Healing process. Those two walls are laying together and they're healing shut together. And so they often scar closed in that cavity. And what can happen is you can get little pockets inside the cavity where it didn't scar completely together, the two walls of the uterus. And say that little pocket starts growing endometrial lining again, and tries to bleed. Each month. You can get little pockets full of blood in your uterine cavity that can't make its way out through the cervix and vagina like a normal period, because there's scarring in the way. And so what we've come to find out is a lot of women will initially have really light periods or no periods, but eventually they start to grow that lining again and they start to bleed again. Or the worst case scenario is they don't bleed out the blood. It stays in the cavity in those little scarred pockets and causes pain every month when this is happening. And so women get stuck in this vicious cycle, it's called cyclical pain, where for a few days or a week every month, they're in a lot of pain because their uterus is bleeding, it can't release it, and it's all scarred up. This issue can be compounded by the burning or scarring of the fallopian tubes, which are the other exit areas of the uterus. So if you have a tubal ligation done with your endometrial ablation or before, after, then you really are trying to scar down this whole uterine cavity so that nothing can escape through the tubes or through the cervix. I hope that makes sense. So there's also a long history when it comes to endometrial ablation. When I was back in residency, like I said, it was all the rage. And all of these medical device companies were coming out with different ways to do the procedure. So there was like a metal ball that you would roll along the lining inside the uterus. This is obviously done in the operating room and surgery. You're asleep. And we would use this metal ball and we would burn the lining. We also would use straight up cautery or energy to burn the lining. We would use hot water to burn the lining. We would use a balloo filled with hot water and send energy through that. And then a mesh type device came out that had little pokey corners and it would kind of fill the cavity and use radio frequency energy to burn that lining. That's still the most popular one to this day. But we unfortunately learned a lot from having a lot of women suffer so what we learned was that the hot water, the energy, all of those ways of doing those things potentially could escape the uterus and burn the bowel and burn the bladder and everything going on in the pelvis had the potential to be damaged. And so there was many years of, like, putting safety mechanisms into place and really changing the devices to make them as safe as possible. So in this day and age, it is pretty darn safe. You know, it's an outpatient procedure. You go to the operating room, usually you get put to sleep. It usually takes about 20 to 30 minutes to do the whole thing. Some doctors even do it in their office. They'll give you a little bit of ice, v sedation, or even just oral medications to calm you and help with pain, like Valium and Motrin. So there's a lot of different ways to do it. And for a lot of women, they're really happy that they did it. But I will tell you, there are also a lot of women who regret it and go on to have complications afterwards. So it might not be that you necessarily are going to have a complication from the procedure itself, but it could very well be that you have a complication three years, five years down the road. So I really want you to keep that in mind. But the even bigger, more important piece of all this is we need to ask why. Why were your periods heavy in the first place? Because an endometrial ablation is band aid medicine. It's getting rid of that symptom of that heavy period, but not actually fixing why it was going on. The problem is not that your endometrial lining is growing. It's supposed to do that. The problem is that your hormones are out of balance. You most likely have estrogen dominance. And it could be from a few different things. It could be that you are not ovulating every month. You're not making the progesterone needed to keep estrogen balanced and in check. That's a very common scenario, especially women after 40. We start to lose some of our eggs. We run out of them, quote, unquote. And so we don't ovulate consistently. Stress is a huge reason that we stop ovulating and don't make progesterone. So if we are making cortisol all day, our stress hormone, that robs us of our progesterone, and that can cause an imbalance. Estrogen dominance can come from carrying extra weight. We actually make estrogen in our fat cells. We convert it from testosterone more than anything. So carrying extra weight can cause estrogen dominance. And that is why obesity is one of the risk factors for. For uterine cancer, which is all stems from estrogen dominance. So you always want to be asking why? A few other reasons. Xenoestrogens. So all of the plastics and the fragrances in our environment that we're bombarded with every day, those get into our body and they bind to the estrogen receptors and send signals like estrogen to stimulate that growth lining. And so if you're using tampons and pads that aren't organic that have all these toxins in them, it's going directly into the uterus and stimulating that growth. If you are wearing fragrances and using fragrance plugins or car fresheners, all of those things, those go into your body and send warp signals. If you're heating your food in plastic, if you're drinking out of plastic water bottles, if you the tops on to go cups for coffee, those are all plastic. And the hot coffee releases those plastics into your mouth every day. And that can drive estrogen dominance. So there's a lot of things also how your liver is metabolizing your estrogens. So if our liver isn't metabolizing estrogen properly, our body will send estrogen down a different pathway that will convert it to estrone, and that is more stimulating to the uterus and can cause this overgrowth and estrogen dominance picture as well. So it's super important that you got to get those antioxidants into your diet every day. You have to eat the rainbow. You got to get all those brightly colored vegetables in for your antioxidants. I want you taking NAC every day. That helps you make glutathione. Your major antioxidant. NAC is in my energy lift. The B vitamins are in there. Everything that you need to metabolize your estrogen and keep you out of this picture of imbalance. So energy lift is literally for every woman. Like, you should be on it, because it really does help you metabolize your estrogen properly and hopefully reverse or prevent estrogen dominance. So I want you asking why. Why do you need an endometrial ablation? And some women are at the point where the estrogen dominance has been going on for so long that they are anemic. Right. I've had patients who've had blood transfusions who come to me, and they're at their wit's end because they cannot get control of this heavy bleeding. If you're already down that path and you feel like, yes, I need this ablation to stop this cycle. Okay? I just want you know, to know what you're signing up for. And complete informed consent is truly the only thing that matters to me. And you're not getting complete informed consent from your gynecologist. They're not talking to you about why the heavy period is happening. So if you have the ablation, know that there's a potential for issues later on, you might end up with a hysterectomy because of that chronic cyclical pain, that scarring, that lining, trying to grow back. That's a really common scenario as women go on to have a hysterectomy after that. But the bigger, bigger, bigger, bigger issue is you have to still address the estrogen dominance. So even if you do the ablation to get control, to stop the anemia, to stop feeling exhausted, to all, you know, stop missing work, you. You still have to deal with estrogen dominance. But why? Right? So women are like, it's fine if my period is no longer heavy. Why do I care if I'm in an estrogen dominant state? So here's the thing, you guys, women who have chronic estrogen dominance and don't actually fix that imbalance, that is what can drive breast cancer and uterine cancer and a lot of other issues. So if you have an ablation and you continue to have estrogen dominance, it's very common for a woman in that scenario to go on and be diagnosed with breast cancer a few years later. I've seen it way too many times to count in my practice. It's. It breaks my heart because so much of this is preventable if we stop and ask why. So if you're in an estrogen dominant state and you are continuing to stimulate the breast tissue in the uterine tissue with the wrong type of estrogen, you know, the four hydroxy estrone metabolite that we don't want too much of, that you're probably making too much of. In an estrogen dominant state, along with not having enough antioxidants, drinking alcohol, carrying extra weight, having a poor diet, having a messed up gut microbiome that is the perfect storm for cells to go rogue and grow into cancer. Our body is supposed to remove damaged cells and DNA and get them, get rid of them. But they need the ingredients and the tools to do that. And if we don't give that to our body, our body cannot fight that off and prevent cancer from growing. And so I really want you to feel empowered by this conversation today because now you can say, okay, why Am I thinking about having an endometrial ablation now? I understand it's not going to fix the real root cause of the problem. It's going to fix a symptom of my problem. And maybe I need that fix and maybe I don't. Maybe if. Maybe it's not so far gone that I just focus on the estrogen dominance issue and correct that my periods will go back to normal and be short, three to five days, not heavy, totally manageable, not painful the way they're supposed to be. So please think about all of this stuff and share this episode with all the women you know, because I don't think that we are talking to each other enough about these issues. There's no shame around what's happening in our bodies, and so much of it is in our control. That's the really cool thing. And so if you figure out, like, start working with a functional practitioner, work with my team, figure out what you need to do to shift that hormone in balance and get it into balance, right? Shift, bring that estrogen down, bring the progesterone up, help the liver metabolize your hormones better, make sure your gut is balanced and all of that. And you're actually going to make a huge shift on so much stuff. And this also does affect your weight, which I know so many of you are struggling with weight during these hormone imbalances, and most doctors, unfortunately, are just telling you to eat less and exercise more. And that is absolutely the wrong advice. It's actually completely opposite of what you should be doing. But until you get your estrogen balanced, you're going to struggle with weight. That's just how it works. Okay? So if you want more details and you want to understand estrogen dominance more and what to do about it, you can definitely schedule a call with my team and we can talk to you about options of getting you evaluated and taken care of. Or if you want to, just listen to my podcast, episode number 67, is your life being controlled by estrogen? It really talks in more detail about what you can do on your own to shift your hormones and get them back into balance. So that's a really awesome episode. Go check that out. And remember, podcasts have a lot of amazing, valuable episodes way back when, Right? So I know for myself, I tend to listen to the podcast of whatever that comes out for the week, you know, whatever I'm listening to. And I don't think to go back and listen to old episodes. I always just listen forward. But the cool thing about podcasts is you can scroll back, they're there forever. So I really encourage you, go back into the playlist of the gutsy Gynecologist show. It was originally called the Functional Gynecologist Podcast. And look at the titles and see. See if any of them resonate with you. Because I promise you that there is so many golden nuggets of information that you need as a woman and that you can share with your friends and your sisters and your moms and everybody else. So much stuff. I mean, I taught I. Way back in the beginning of the podcast, I talked about how menstrual cycles are our vital sign. They tell us how our health is going every month based on how the period is presenting. You know, if it's heavy, if it's painful, if it's long, if it's short, if it's early, like, that is a really cool episode. Every woman needs to understand how to use their period as a vital sign. So go back and listen to that. I think it was like episode two or something. But I talk about, like, so many things women just need to know, like basic knowledge that we should have been taught growing up as a young woman that we weren't taught basic knowledge that your gynecologist has forgotten or never learned because they are in fact, surgeons, not hormone experts. I had to go and study extra for extra years to really understand hormones to and what drives GYN conditions. So pills and surgeries are not the answers. Those are the band aids to get rid of the symptoms, but it doesn't fix the root cause of the issues that are going on. So I talk about the immune system and the lymphatic system and how exercise impacts us and different nutrients, different vitamins, mindset shifts, beliefs, histories of trauma prevention and recurrence of breast cancer. Like, it goes on and on and on. Fibroids, pcos, endometriosis, ovarian cysts, like, so many amazing episodes. And I'll give you a little hack what I love to do. There's a few podcasts I listen to where they talk a little bit slower. And maybe you think I talk slow so you can literally go in and change the speed and at which you listen to the podcast. And so I'll listen to some podcasts at one and a quarter speed or one and a half even. And then if it's something that I'm like, oh, I did not understand that, let me go back and I slow down the speed and listen to it slower so that I can really comprehend what they're saying. So that's my little hack of getting in a lot of podcast episodes. And remember, like you can just pause it, come back later. You don't have to have the whole time period right now to listen to it. So really embrace this idea that so much education and information is at your fingertips. It is up to you to take back control of your body and your health. And that is what I'm encouraging you to do. Do not rely on the white coat to tell you what to do with your body. That way of thinking is over. Like literally when your doctor says you need an ablation or you need a hysterectomy, you need these birth control pills. Please just take a time out and and question it and ask why and they probably don't have the answers. So the answers are in the podcast episodes. Okay? So I really want you to just be more mindful and discerning when it comes to your body and your health and how decisions you're making today are are going to affect your future health. Breast cancer doesn't just pop out of nowhere. Uterine cancer doesn't pop out of nowhere. Diabetes doesn't pop out of nowhere. Carrying a extra weight around is not for no reason. Like there are root causes to all of this. If you want to understand thyroid, I have thyroid issues if you want like so many root cause issues. Mold, lime, all kinds of, you know, fibromyalgia and stuff that doesn't get talked about. So please check it out, let me know what else you want to hear about. I love getting these requests and doing these episodes for you. I hope you found so much value in this and I would be super grateful if you would hit the subscribe. Maybe a five star review, let me know what you're thinking, what else you want to hear about. Okay. So go have an amazing kick ass week. God created you to do beautiful, amazing things and your body is fully capable of transformation. So believe in you, believe in your body's ability to do that and have a great week. I'll see you guys soon.