QC: Uterine Ablation vs. Hysterectomy: What If A Provider Doesn't Believe You?

Dr. Jeff Arrington breaks down the differences between uterine ablation and hysterectomy while offering candid advice about advocating for yourself with dismissive doctors. His expert insights challenge conventional approaches to endometriosis and adenomyosis treatment, emphasizing the importance of evidence-based care and patient autonomy.

• Uterine ablation uses heat to destroy the uterine lining and primarily treats heavy bleeding, not painful periods
• Adenomyosis is one of the top reasons patients need hysterectomy after endometrial ablation
• For heavy bleeding with painful periods, a progesterone IUD may be better than ablation as it addresses both symptoms
• Post-ablation syndrome can occur when scarring traps active endometrial tissue, causing pain over time
• When doctors don't listen to your concerns, asking for supporting research studies may help
• If providers consistently dismiss you, finding a new doctor may be your only viable option
• Many physicians remain fixed in outdated residency training and fail to offer referrals to specialists

Have more questions? Send them in using the link in the episode description, email contact@endobattery.com, or visit the endobattery.com contact page.

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Chapters

• 0:00 Introducing Quick Connect Format
• 0:37 Dr. Jeff Arrington Introduction
• 1:11 Uterine Ablation vs. Hysterectomy
• 2:16 Advocating When Doctors Don't Listen
• 4:35 Episode Closing & Contact Info

Transcript

Speaker 1: 0:00

Life moves fast and so should the answers to your biggest questions. Welcome to EndoBattery's Quick Connect, your direct line to expert insights. Short, powerful and right to the point. You send in the questions, I bring in the experts and in just five minutes you get the knowledge you need. No long episodes, no extra time needed, and just remember expert opinions shared here are for general information and not for personalized medical advice. Always consult your provider for your case-specific guidance. Got a question? Send it in and let's quickly get you the answers. I'm your host, alana, and it's time to connect. Today I have an incredible expert joining us Dr Jeff Arrington. If you've spent any time in the endometriosis community, you've probably heard his name. Dr Arrington isn't just an excision specialist. He's a fierce advocate for informed consent and breaking down the barriers that keep so many from accessing proper endometriosis care. His passion goes beyond the operating room. He's fighting for real change, pushing back against misinformation and making sure that patients have the knowledge and options they deserve. Let's dive in. Is a uterine ablation an adequate replacement for a hysterectomy?

Speaker 2: 1:14

It depends on what they're trying to treat. As far as I know, uterine ablation is basically using heat to destroy the lining of the uterus. It is a treatment for heavy bleeding. I don't know if it's a treat for painful periods. I haven't really dealt with that for years after focusing on the endo, but back when I was doing a lot of that, to my knowledge, back then it was a treatment for heavy bleeding, not painful periods. Interestingly, adenomyosis is one of the top two reasons why patients go on to have hysterectomy after an endometrial ablation, and so, in my view, if there's heavy bleeding and very painful periods, that really raises the suspicion of adenomyosis, and if patients don't want a hysterectomy, my opinion of progesterone IUD is a better option than a uterine ablation, because you still have a chance of decreasing bleeding, which is the role of the ablation, but you also have it's a proven treatment for period cramping as well.

Speaker 1: 2:09

What are the risks of doing a uterine ablation?

Speaker 2: 2:12

I mean patients that have had multiple prior C-sections. There's worry about burning too deep and going into the bladder. I think that's pretty rare. Risks continued bleeding and spotting. There is something called post-ablation syndrome, where the ablation is meant to burn the lining of the uterus but it's never 100% and it causes a lot of scarring. The lining inside the uterus is scarred down and there's still active endometrium higher up. It can get trapped and over time can become painful and problematic Again, if there's adenomyosis they're kind of the same thing it traps those glands in the muscle. So the post-ablation syndrome is probably the most common. I think they're pretty well tolerated as a procedure itself. I think the major complication rate is pretty low. It's more outcomes-driven than true complications.

Speaker 1: 2:56

How does someone advocate for themselves when their doctor doesn't take them seriously?

Speaker 2: 3:01

I mean, all you can do is try and say hey, this is what I'm concerned about. If they don't listen, you can't make them listen, and the only thing I can think of is to find somebody else. I don't know.

Speaker 1: 3:13

Yeah, and that's something that I feel like, as advocates, we kind of see a lot more of is just ways of communicating that the approach that this provider is taking is not helpful. And I think it's okay to be honest with a provider and say this is not helpful. I need either a referral to a new provider or you let them know post seeing another provider what the findings are.

Speaker 2: 3:36

Yeah, yeah, you know, and if the response is always I mean the heart most likely the response is, well, let's just try this hormone, or let's try this hormone, or, you know, there's nothing more I can do, where you just need to get pregnant or you need to have a hysterectomy. You know, if a patient really wants to be I mean, I'm probably super passive-aggressive by nature, but if a patient wants to be passive-aggressive, I mean they could just ask the doctor, say, okay, you know, I'm interested in that. Can you show me some studies that support that? You know the hard part most are just kind of ingrained in what they learned in residency and really haven't learned anything beyond that. You know, and even, and they may even know, doctors that do excision and do complex endometriosis surgery and for some reason they just stick to their guns and they don't offer that as an option. But you know, if you're not being heard and you try to, you try to advocate and you're still not being heard, in my mind you only, the only option left is to find somebody else.

Speaker 1: 4:31

That's a wrap for this Quick Connect. Find somebody else. That's a wrap for this quick connect. I hope today's insights helped you move forward with more clarity and confidence. Do you have more questions? Keep them coming, send them in and I'll bring you the expert answers. You can send them in by using the link in the top of the description of this podcast episode, or by emailing contact at endobatterycom or visiting the endobatterycom contact page. Until next time, keep feeling empowered through knowledge.