Dr. Sharon Buzi, MD

There are many different ways that the uterine lining can be removed, including radiofrequency, heat, microwaves, and cold. Ablations are usually performed with local anesthetic by an OB/GYN. A probe is inserted into the uterus through the vagina, and the end of the probe is expanded or moved around to access the uterine lining. Cramping and discharge afterwards are normal, but the procedure is not particularly painful.

Endometrial ablation is not for everyone. It shouldn't be done by women who have reached menopause, or women with uterine cancer or uterine infections. It is important to remember that an endometrial ablation does not remove the uterus or ovaries, so regular pelvic exams are still important after this procedure. Women who are considering endometrial ablation should also be done having children. Pregnancy is possible after an endometrial ablation, though not likely. If pregnancy does occur, an ablation increases the risks of miscarriage and other problems, so reliable birth control must be used after endometrial ablation all the way through menopause.

If surgery is necessary, hysteroscopy is often used along with laparoscopy, a kind of surgery performed through small incisions in the abdomen. Tiny tools are passed through the incisions, and the hysteroscope guides the doctors while surgery is performed.

The choice of treatment for pelvic organ prolapse depends on the severity of the condition. Mild to moderate prolapse may be managed by doing pelvic floor strengthening exercises, taking hormone replacement therapy, or using pessaries. Pessaries are small devices inserted into the vagina to help support the pelvic organs. Pessary fitting is a quick procedure done in a doctor's office. For severe prolapse, surgical treatment may be necessary. Pelvic organ prolapse surgery repairs the following:

• Cystocele or bladder prolapse, where the bladder sags into the vagina. The surgeon repairs a cystocele by strengthening the front wall of the vagina using stitches so that the bladder will no longer sag.
• Enterocele or small bowel prolapse, which occurs when the small bowel descends towards the vagina. To correct an enterocele, the tissues between the small bowel and the vagina are sewn together, allowing them to provide more support.
• Rectocele or posterior prolapse, which is the bulging of the front wall of the rectum into the back wall of the vagina. Surgery to repair a rectocele removes the excess stretched tissue between the rectum and vagina.
• Uterine prolapse, which occurs when the uterus slips down to the vagina. To treat a uterine prolapse, the surgeon may secure the neck of the uterus (called cervix) to a ligament in the pelvis using stitches. Another option for this type of prolapse is a vaginal hysterectomy, which is the removal of the uterus.

Each of these procedures is performed through a vaginal incision, but an enterocele repair may use the abdominal approach as an alternative. If two or more pelvic organs have prolapsed, a combination of any of these procedures may be performed during the same surgical session.

For women who no longer wish to have intercourse, an operation called colpocleisis

may be a surgical option as well. By closing the vaginal canal, colpocleisis treats pelvic organ prolapse and eliminates any risk of its recurrence.

In most instances, pelvic organ prolapse surgery only requires a hospital stay of one day. Patients may experience vaginal bleeding for the first few weeks following surgery. If this happens, patients should use sanitary pads rather than tampons, as a higher risk of infection is associated with the use of tampons. To further help with recovery, patients should begin doing gentle pelvic floor strengthening exercises a few days after surgery. Doing these exercises at least three times a day as a routine tightens the pelvic floor muscles and prevents the recurrence of prolapse.