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    Endometrial ablation


    Definition of endometrial ablation

    A procedure called endometrial ablation destroys the endometrium — the lining of your uterus — with the goal of reducing your menstrual flow. In some women, menstrual flow may stop completely. No incisions are needed for endometrial ablation. Your doctor inserts slender tools through your cervix — the passageway between your vagina and your uterus.

    The tools vary, depending on the method used to destroy the endometrium. Some types of endometrial ablation use extreme cold, while other varieties depend on heated fluids, microwave energy or high-energy radiofrequencies.

    Some types of endometrial ablation can be done in your doctor’s office, while others must be performed in an operating room. Factors such as the size and condition of your uterus will help determine which endometrial ablation method is most appropriate.

    Why it’s done

    Each month during menstruation, you shed the lining (endometrium) of your uterus. Endometrial ablation treats excessive menstrual blood loss, which may be indicated by:

    • Unusually heavy periods most months
    • Enough blood loss to soak through a pad or tampon every hour on the heaviest days
    • Anemia from excessive blood loss

    Several options exist to help reduce menstrual bleeding. Doctors may prescribe medications or a progesterone-releasing intrauterine device (IUD) as the first line of treatment for heavy menstrual bleeding, but endometrial ablation may be an option if medications or an IUD don’t help.

    Endometrial ablation is not recommended for women who:

    • Wish to become pregnant in the future
    • Have significant cramping with menstrual periods
    • Have cancer of the uterus
    • Were recently pregnant
    • Are past menopause

    Risks of endometrial ablation

    Endometrial ablation risks may include:

    • A puncture injury (perforation) of the uterine wall from surgical instruments
    • Heat or cold damage to nearby organs
    • Pain, bleeding or infection

    Future fertility

    After endometrial ablation, pregnancy is still possible in some women. However, these pregnancies may be higher risk to both mother and baby. The pregnancy may end in miscarriage because the lining of the uterus has been damaged. Women who want to become pregnant in the future should not have endometrial ablation. Some women choose a sterilization procedure at the time of endometrial ablation to prevent pregnancy.

    How you prepare for endometrial ablation

    In the weeks before the procedure, your doctor may:

    • Check for cancer. Your doctor may take a small sample of your endometrium — using a narrow tool inserted through the opening of your cervix — so it can be tested for cancer. If you have cancer, you’ll probably need to have a hysterectomy instead of endometrial ablation.
    • Thin your endometrium. Endometrial ablation is often more successful when the uterine lining is thin. This can be accomplished with medications or by having a dilation and curettage (D&C), a procedure in which a doctor scrapes out the extra tissue.
    • Discuss anesthesia options. Some methods of endometrial ablation require general anesthesia, so you are asleep and feel nothing during the procedure. Other types of the procedure may be performed with conscious sedation or with numbing shots into your cervix and uterus.

    What you can expect

    Many of the newer methods of endometrial ablation can be performed in your doctor’s office. But some types of endometrial ablation are performed in a hospital, especially if you will need general anesthesia.

    The opening in your cervix needs to be dilated to allow for the passage of the instruments used in endometrial ablation. Dilation of your cervix can happen with medication or the sequential insertion of a series of rods that gradually increase in diameter.

    Endometrial ablation procedures vary by the method used to destroy your endometrium. Options include:

    • Electrosurgery. This method uses a slender scope to see into the uterus during the procedure. An instrument passed through the scope — for instance, a roller ball, spiked ball or wire loop — becomes hot and is used to carve furrows into the endometrium. Electrosurgery requires general anesthesia and generally takes 30 minutes or less to complete.
    • Extreme cold. Cryoablation uses extreme cold to create two or three ice balls that freeze and destroy the endometrium. Real-time ultrasound allows the doctor to track the progress of the ice balls. Each freeze cycle takes up to 6 minutes to complete; the number of cycles needed depends on the size and shape of your uterus.
    • Free-flowing hot fluid. Saline fluid heated to 176 to 194 F (80 to 90 C) is circulated within the uterus for about 10 minutes. This method can be more painful than other office-based methods, but it’s the method most likely to get complete coverage.
    • Heated balloon. A balloon device is inserted through your cervix and then inflated with fluid heated to 188.6 F (87 C). The balloon helps prevent fluid from escaping up the fallopian tubes, but the balloon sometimes isn’t flexible enough to contact the entire endometrium. This method takes about 10 minutes to complete.
    • Microwave. In this method, the doctor inserts a slender wand that emits microwaves, which elevate the temperature of the endometrial tissue to 167 to 185 F (75 to 85 C). The doctor moves the wand from side to side while pulling it out of the uterus. Total treatment time is usually three to five minutes.
    • Radiofrequency. A more automated method of endometrial ablation uses an instrument that unfurls a mesh electrode array within the uterus. The mesh transmits radiofrequency energy that vaporizes the endometrial tissue within 80 to 90 seconds.

    After the procedure

    After endometrial ablation, you may experience:

    • Cramps. You may have menstrual-like cramps for a few days. Over-the-counter medications such as ibuprofen or acetaminophen can help relieve cramping after the procedure.
    • Vaginal discharge. A watery discharge, mixed with blood, may occur for a few weeks. The discharge is typically heaviest for the first few days after the procedure.
    • Frequent urination. You may need to pass urine more often during the first 24 hours after endometrial ablation.

    You may need to avoid intercourse and tampon use for a period of time after the procedure. Ask your doctor how long you should wait before resuming these activities.

    Results of endometrial ablation

    It may take a few months to see the final results, but endometrial ablation usually succeeds in reducing the amount of blood lost during menstruation. Most women will have lighter periods, and some will stop having periods entirely.

    Continue to use contraception, though, because endometrial ablation isn’t a sterilization procedure. Pregnancy may still be possible, but it will likely be hazardous and end in miscarriage.

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