Endometrial ablation - am I right that this is wrong?

[Elzee]

I’m reading a pamphlet that describes a procedure called ‘endometrial ablation’. Basically the endometrium is ‘removed’ - its ability to grow back is hindered and typically does not grow back. It’s a treatment for certain problems associated with a woman’s period. It’s not meant as a form of birth control, although I have a sick feeling it could eventually be touted as that…although I could be wrong…

Have any of you heard of this? Conception can still occur, but implantation is hindered because the lining is non-condusive.
The pamphlet I’m reading is really upsetting because it says: *“Most women are not able to become pregnant, but conception is still possible”. * In other words, you’re not pregnant until implantation has occurred! Does anyone know if the Church or possibly Priests for Life has commented on this procedure?

 

[axolotl]

My mother had that done a few years ago. She would have preferred a hysterectomy but her doctor insisted in this less drastic procedure.

She was 49 years old.

She had started to have very short cycles, with very heay bleeding.

 

[1ke]

Elzee:

I’m reading a pamphlet that describes a procedure called ‘endometrial ablation’. Basically the endometrium is ‘removed’ - its ability to grow back is hindered and typically does not grow back. It’s a treatment for certain problems associated with a woman’s period.

It is a treatment for those suffering severe endometriosis, fibroids, and certain other conditions that cause severe bleeding and pain. It is an alternative to hysterectomy, in some cases.

Elzee:

It’s not meant as a form of birth control, although I have a sick feeling it could eventually be touted as that…although I could be wrong…

I don’t think this is the case. Endometrial ablation has been around since the late 70s. It’s not a new procedure. It is a pretty serious procedure, and done for the reasons mentioned above. Like a hysterectomy, it’s not something likely to be done merely for contraceptive purposes. I suppose anything is possible, but I think it unlikely.

Elzee:

Have any of you heard of this?

Yes.

Elzee:

Conception can still occur, but implantation is hindered because the lining is non-condusive.

That is why a woman considering it should also consider a hysterectomy. Using conservative NFP rules would be an option to avoid conception indefinitely.

Elzee:

The pamphlet I’m reading is really upsetting because it says: *“Most women are not able to become pregnant, but conception is still possible”. * In other words, you’re not pregnant until implantation has occurred!

While it is certainly inaccurate, this is the standard definition adopted by the AMA a number of years ago. The AMA defines pregnancy as implantation, not conception. They used to define it as conception.

Elzee:

Does anyone know if the Church or possibly Priests for Life has commented on this procedure?

The Church has no statement on this procedure. It is a legitimate medical procedure and many women can choose it over the more invasive and problematic hysterectomy option. NFP can be successfully used to avoid conception.

I believe there are several women who post here who have had the procedure so perhaps one of them will reply to you.

 

[Elzee]

Would this procedure be approved by the Church, thought, if a woman hasn’t gone through menopause since it can work as an abortifacient? (from what I understand, anyway).

 

[Della]

As a Catholic I don’t believe a married woman of child-bearing age should have this procedure because it stops the fertilized egg from attaching to the uterus. Also, the symptoms that might cause a woman to get such a procedure probably wouldn’t fall under the need for removal of the uterus or the lining of the uterus to save the woman’s life with abortion or infertility being the secondary effect, which is the only reason such procedures are allowed by the Church.

Better to contact The Pope Paul VI for information and further contacts with fertility clinics that practice medicine in line with the teachings of the Church with regard to women’s issues instead of subjecting oneself to the secular solutions offered by medical institutions that see surgery and contraception as the answers to everything.

 

[1ke]

Elzee:

Would this procedure be approved by the Church, thought, if a woman hasn’t gone through menopause since it can work as an abortifacient? (from what I understand, anyway).

NFP can be used to avoid conception.

 

[oldfogey]

If the primary intent of the procedure is to treat heavy menstrual bleeding which threatens a woman’s health, and not to contracept, but the procedure has the unintended consequence of leading to infertility, it is not against Church teaching.

I don’t think we should confuse the poster’s question with “preferences.” That is, if a woman needs this procedure, which is less drastic than a hysterectomy, I don’t think she has to commit to NFP or abstinence to feel that she has made a moral choice.

 

[Elzee]

oldfogey:

If the primary intent of the procedure is to treat heavy menstrual bleeding which threatens a woman’s health, and not to contracept, but the procedure has the unintended consequence of leading to infertility, it is not against Church teaching.

I don’t think we should confuse the poster’s question with “preferences.” That is, if a woman needs this procedure, which is less drastic than a hysterectomy, I don’t think she has to commit to NFP or abstinence to feel that she has made a moral choice.

But, regardless of the intent, if the procedure is known to have abortifacient effects (does not allow a fertilized egg to implant - much like the pill can do) can it be an option for Catholic woman unless it is needed to save her life? I don’t see how it could be?

 

[1ke]

Della:

Also, the symptoms that might cause a woman to get such a procedure probably wouldn’t fall under the need for removal of the uterus or the lining of the uterus to save the woman’s life with abortion or infertility being the secondary effect, which is the only reason such procedures are allowed by the Church.

This is an incorrect statement of church teaching on the subject. The Church does not teach theraputic means such as this can only be used when one has a life-threatening condition.

Della:

Better to contact The Pope Paul VI for information and further contacts with fertility clinics that practice medicine in line with the teachings of the Church with regard to women’s issues instead of subjecting oneself to the secular solutions offered by medical institutions that see surgery and contraception as the answers to everything.

Second opinions are always a good idea. But, this surgery is not something that is recommended lightly or for just any old reason. Some women who have severe bleeding/endometriosis, fibroids, and severe pain have a debilitating condition that requires treatment-- either ablation or hysterectomy.

 

[1ke]

Elzee:

But, regardless of the intent, if the procedure is known to have abortifacient effects (does not allow a fertilized egg to implant - much like the pill can do) can it be an option for Catholic woman unless it is needed to save her life? I don’t see how it could be?

A person can practice NFP to avoid conception after this procedure and use conservative, post ovulation times of infertility for relations.

One cannot do so with the pill because the pill alters the woman’s fertility signs.

 

[Elzee]

1ke:

A person can practice NFP to avoid conception after this procedure and use conservative, post ovulation times of infertility for relations.

One cannot do so with the pill because the pill alters the woman’s fertility signs.

But even NFP isn’t 100% effective and there is still the chance for conception.

 

[Matt_Collins]

It seems to me that the “Principle of Double Effect” (PDE) would apply here. Simply stated, the PDE helps us answer the question “May I take this particular action if I can foresee that it may have two effects, one good and the other evil?” The answer is “Yes”, if ALL of the following conditions are met:

1. The action itself is either morally neutral or morally good.
2. The intent is ONLY to achieve the good effect.
3. The evil effect does not cause the good effect.
4. There is at least a reasonable proportion between the good effect and the evil effect.

The PDE is how moral theologians have justified surgery to remove an ectopic pregnancy, for example, in which it is clear that all four conditions are met.

With endometrial ablation in a fertile woman, however, I don’t believe it is quite so clear.

1. The action in itself certainly can be considered morally neutral, if not even morally good.
2. The intent is only the good effect: to relieve the woman’s suffering, and presumably in certain cases, even her life.
3. The evil effect (the inability of a fertilized egg to implant in the uterus and thus to grow to maturity) is obviously NOT the cause of the good effect.
4. The potential problem I see is in the proportionality between the good effect and the evil effect. If the procedure is being done to relieve the woman’s suffering (as opposed to saving her life), I think it would have to be pretty extreme suffering to justify the loss of life of potentially many babies. And even if the intent is to save the life of the woman, it is only one life (the mother’s) vs. potentially many lives.

The problem I see in # 4 is increased by the availability of at least one reasonable alternative: a hysterectomy.

Of course, I could be wrong. It is my understanding that, using the Principle of Double Effect, the Church allows women to take the pill for medical reasons (e.g., the regulation of a woman’s cycle), and the pill can also cause an abortion. I personally don’t agree, but I’m not authorized to teach in the Church’s name!

My intent is not to provide a definite answer, but rather, simply to provide a framework, consistent with Catholic teaching, for evaluating the circumstances and issues involved in the general case of endometrial ablation in a fertile woman.

 

[1ke]

Elzee:

But even NFP isn’t 100% effective and there is still the chance for conception.

I believe that the Principle of Double Effect is met when examining the procedure in conjunction with the conservative use of NFP. The chance of conception using conservative, post ovulatory NFP is remote, and failure to implant is not a certainty.

You may disagree with me on whether or not it does meet the criteria of double effect.

The Church has no definitive teaching on this particular matter, it does not forbid the procedure, therefore a well-formed conscience is appropriate and up to the individual. We can, legitimately, come to different opinions on this matter.

 

[mosher]

I also feel that he principle of double effect applies to this issue. It seems to me that there is only a possibility that the uterine wall will be non-conducive. The intent of the procedure is to solve a possibly serious medical issue in the same line as a hysterectomy. Thus, as long as the person does not have the procedure done with the intent or the desire to become infertile then it is morally acceptable. For some this may even be a better choice than a hysterectomy because it still allows for the possibility of becoming pregnant.

 

[steveandersen]

Matt Collins:

… And even if the intent is to save the life of the woman, it is only one life (the mother’s) vs. potentially many lives…

Potentially.

At the time the procedure is done, no conception has taken place so the only life in the balance is the mother’s.

 

[Della]

1ke wrote:

Second opinions are always a good idea. But, this surgery is not something that is recommended lightly or for just any old reason. Some women who have severe bleeding/endometriosis, fibroids, and severe pain have a debilitating condition that requires treatment-- either ablation or hysterectomy.

The Paul VI Institute isn’t merely a second opinion, it’s treating women as women not as objects of “slice and dice” medical mentality that thinks first of destroying the symptoms before treating the root causes of women’s disorders.

I suffered from endometriosis, fibroids, and severe pain for many, many years, but I didn’t get my womb scrapped because I didn’t want to be sterilized while I was of childbearing age.

And, getting oneself sterilized, unless it is for a grave reason, is a mortal sin. The OP ought to talk to her confessor before agreeing to any procedure that would do that to her. Besides, I highly recommend getting the “second opinion” of the Paul VI Institute to see what treatments might be available to avoid the need for surgery in the first place.

 

[1ke]

Della:

The Paul VI Institute isn’t merely a second opinion, it’s treating women as women not as objects of “slice and dice” medical mentality that thinks first of destroying the symptoms before treating the root causes of women’s disorders.

I am well aware of the Pope Paul VI institute as I am under the guidance of a Fertility Care Practicioner, and yes, they are a second opinion or a first opinion if you go to them first.

PPVI deals primarily with helping couples achieve conception when they have subfertility and infertility. Sever endometriosis and fibroids can be far beyond that scope and not treatable via other means that PPVI uses such as natural hormones, etc.

Sometimes it can be, and certainly it should be, but when other means have failed ablation and/or hysterectomy are valid treatments. It is unfair to characterize a doctor who recommends this treatment as having a “slice and dice” mentality.

Della:

I suffered from endometriosis, fibroids, and severe pain for many, many years, but I didn’t get my womb scrapped because I didn’t want to be sterilized while I was of childbearing age.

And that was *your * choice. It is not the required choice.

Della:

And, getting oneself sterilized, unless it is for a grave reason, is a mortal sin.

Direct sterilization is a mortal sin for any reason.

Treating endometriosis or fibroids through ablation is not sterilization any more than chemo and radiation for Hodgkins is sterilization. Sterilization results from treatment, the treatment is not procured for the purpose of sterilization. And it is not sinful to do so.

Della:

The OP ought to talk to her confessor before agreeing to any procedure that would do that to her. Besides, I highly recommend getting the “second opinion” of the Paul VI Institute to see what treatments might be available to avoid the need for surgery in the first place.

PPVI is a great medical facility and a shining star in Catholic health care. However, it does not treat every condition and not every woman can go to them. Yes, a second opinion and a well formed conscience are both sound ideas.

 

[Matt_Collins]

steveandersen:

Potentially.

At the time the procedure is done, no conception has taken place so the only life in the balance is the mother’s.

Good point. I’m not sure it convinces me, but it is certainly at least part of the equation.

Of course, in the case at hand, it would be some relatively limited number of embryos that would potentially die. But the fact that we’re talking about embryos that may only potentially die does not, by itself, mean that it is not a serious concern.

Simply to illustrate my point, if a hypothetical action I’m considering produces complete relief from my very serious suffering, but might reasonably be expected to cause the deaths of millions of people in the future, the proportionality requirement for the Principle of Double Effect would not be met, IMHO.

So in the case of endometrial ablation of a fertile woman, how many potential deaths would there be? Obviously less than a million, but probably more than one. Where’s the line? I don’t presume to know.

My only point is that just because the deaths the procedure may cause in the future are potential, that doesn’t mean that the proportionality requirement of the Principle of Double Effect is met. We also have to consider how likely those deaths are, and how many could reasonably be expected to occur.

I don’t have the answers to those questions.

 

[Della]

Originally Posted by Della
The Paul VI Institute isn’t merely a second opinion, it’s treating women as women not as objects of “slice and dice” medical mentality that thinks first of destroying the symptoms before treating the root causes of women’s disorders.

1ke wrote:

I am well aware of the Pope Paul VI institute as I am under the guidance of a Fertility Care Practicioner, and yes, they are a second opinion or a first opinion if you go to them first.

PPVI deals primarily with helping couples achieve conception when they have subfertility and infertility. Sever endometriosis and fibroids can be far beyond that scope and not treatable via other means that PPVI uses such as natural hormones, etc.

Sometimes it can be, and certainly it should be, but when other means have failed ablation and/or hysterectomy are valid treatments. It is unfair to characterize a doctor who recommends this treatment as having a “slice and dice” mentality.

Even though PPVI deals primarily with helping couples achieve conception, they also deal with the root causes of other women’s disorders. So, the OP (if she is the one seeking info about endometrial ablation) should find out for herself if the PPVI can help her, yes?

As to “slice and dice” surgery, it does exist. A dear friend recently had her breast removed even though the biopsy showed no cancer and the surgeon had told her he wasn’t going to remove the whole breast. The poor woman awoke from surgery to find he had removed it anyway telling her he wanted to be “safe.” She later found out he has the reputation of using such draconian methods on his unsuspecting patients. Now, I know that most surgeons wouldn’t do that, but it happens and most doctors are not being taught the treatments the PPVI uses because they are first taught to use the ones their medical schools teach them and that are promoted by the AMA. Yes?

Originally Posted by Della
And, getting oneself sterilized, unless it is for a grave reason, is a mortal sin.

Direct sterilization is a mortal sin for any reason.

Treating endometriosis or fibroids through ablation is not sterilization any more than chemo and radiation for Hodgkins is sterilization. Sterilization results from treatment, the treatment is not procured for the purpose of sterilization. And it is not sinful to do so.

I didn’t/don’t disagree with this.

Originally Posted by Della
The OP ought to talk to her confessor before agreeing to any procedure that would do that to her. Besides, I highly recommend getting the “second opinion” of the Paul VI Institute to see what treatments might be available to avoid the need for surgery in the first place.

PPVI is a great medical facility and a shining star in Catholic health care. However, it does not treat every condition and not every woman can go to them. Yes, a second opinion and a well formed conscience are both sound ideas.

Once again, I agree.

 

[Delp]

I had this procedure performed because I was bleeding so heavily that at times I was anemic, I could not take care of my children the way I needed to, I could not leave the house because I was bleeding so heavily and so fast. It took me a few years of contemplating this decision before I decided to do it.

As a Catholic I was well aware that I could still become pregnant but the embryo could not implant and I would miscarry. I would not consider this as an option under those circumstances. I considered a hysterectomy but, the doctors I saw advised against it, it was too drastic. After much prayer and discussion with my husband we opted for him to have a vasectomy and I would do the ablation.

Though, I am well aware of the sin we committed in having his vasectomy, I felt we were committing a far greater sin by having the ablation knowing that I may not have a period and NFP would not be an option thus I would be bring a child into the world who would die no matter what. I know that a sin is a sin. If my periods had not been so disruptive to the well being of my entire family I would not have considered this option. Please know that I am not suggesting this as a solution for anyone else, it is simply the solution we decided upon.