What is endometrial ablation?
Endometrial ablation, also known as a uterine ablation, is a minimally invasive surgery used to treat heavy menstrual bleeding (menorrhagia). It removes a thin layer of tissue in the lining of your uterus. Most women continue to have periods after the surgery, but they are usually lighter.
Your doctor might recommend a uterine endometrial ablation procedure if you have heavy, regular periods that have not improved with medication. It is quick, relatively painless and can be performed as an outpatient surgery.
In some cases, endometrial ablation is an alternative to a hysterectomy (removal of your uterus). It does not affect your hormone levels.
Why is endometrial ablation done?
Around one in five women experience heavy menstrual bleeding that affects their quality of life. In many cases, bleeding can be successfully treated with medication or an intrauterine device (IUD). But if these are not effective, your provider may recommend endometrial ablation.
Endometrial ablation is typically not recommended for women who are past menopause.
It is also not advised for women who have:
- Certain uterine conditions
- Uterine cancer or a heightened risk of developing it
- An active pelvic infection
- Plans for future pregnancy
- Had multiple uterine surgeries
How to prepare for an endometrial ablation
You will have a biopsy a few weeks before your procedure to check for any abnormalities or cancer. Your doctor might use an ultrasound to look at your uterus. They might also ask you to take a hormone that blocks estrogen production for one to three months.
As with any surgery, tell your healthcare provider about any medical conditions you have or medications you take, or if you feel unwell. You may be asked to stop taking certain medicines in the two weeks before surgery, such as aspirin, ibuprofen and warfarin. These can make it harder for your blood to clot.
If you have an intrauterine device, or IUD, it will need to be removed. If you smoke, try to stop, as smoking can slow wound healing. Your doctor can give you advice on quitting.
The endometrial ablation procedure
Endometrial ablation is usually a short outpatient surgery that takes place at a hospital or medical center. Your provider may perform endometrial ablation under local or general anesthesia, so ask in advance if you will need someone to drive you home.
Most people can go home the same day and will be able to resume work or normal activities within one or two days. You will have follow-up appointments with your doctor.
Before the procedure
You might be given medication to take eight to 12 hours before an endometrial ablation. The medication opens your cervix, which makes it easier to insert the scope.
When you arrive at the facility or hospital, you might be given pain medication and medicine to prevent nausea. You will have a chance to ask any questions before the procedure. You will then be given either a local or a general anesthetic.
During the procedure
Your healthcare team will make sure you are as comfortable and relaxed as possible during the procedure. They might dilate your cervix, either by medication or a series of rods that increase in size. A hysteroscope might be used to examine the inside of your uterus.
During an endometrial ablation, your healthcare provider will insert a slender, wand-like device into your vagina. This device passes through the cervix and into the uterus to access the uterine lining. Depending on the method used, the device emits energy, heat or cold to remove or destroy portions of the lining. Options include:
- Cryotherapy ablation: A thin probe is used to apply extreme cold to the uterine tissue. To guide the probe, your healthcare provider places an ultrasound monitor on your abdomen. The duration of the procedure depends on the size and shape of your uterus.
- Heated balloon: A balloon is inserted into your uterus, inflated and filled with hot fluid that destroys the uterine lining. This procedure typically lasts between two to 12 minutes.
- Radiofrequency ablation: A flexible device with a mesh tip is placed into the uterus, where it emits radiofrequency energy to remove uterine tissue. This procedure usually takes one to two minutes.
- Microwave ablation: A probe is inserted into the uterus and uses microwave energy to destroy the uterine lining. The procedure typically lasts three to five minutes.
- Electrocautery ablation: A slender scope is inserted to visualize the inside of the uterus, allowing a tool, such as a wire loop, rollerball tip or electrode, to be passed through it. The tool uses electric current to remove or destroy the uterine lining. Electrocautery ablation requires general anesthesia and is less commonly used compared to other ablation methods.
After the procedure
You will be asked to wait at least two hours and given further pain relief if needed. Your doctor will evaluate you before you are discharged and give you pain relievers to take home. You might need to urinate more frequently for 24 hours, and you may experience cramps, light bleeding and nausea for one or two days.
Common endometrial ablation side effects include a watery discharge mixed with blood for several weeks.
Contact your provider if you have heavy bleeding, severe abdominal pain or abnormal vaginal discharge. Your provider will also advise you about endometrial ablation recovery and returning to exercise, sex and using tampons.
What are the risks of endometrial ablation?
Like all surgery, endometrial ablation carries a risk of complications. These include:
- Bleeding
- Burns to the vagina, vulva and bowel
- Infection
- The device passing through the wall of your uterus or bowel
- In rare cases, fluid used during electrosurgery may enter your bloodstream
Call your OBGYN if you experience any of these symptoms.
Endometrial ablation recovery
You should feel like your normal self within two to three days, allowing you to resume your regular activities. It might take a few months for your uterus to heal and for you to see the benefits of your endometrial ablation.
After 12 months, most women find their quality of life has improved and their periods are lighter. Between 30% and 50% of women stop having periods altogether. This is more common among older women.
Endometrial ablation does not prevent you from getting pregnant. However, it can make getting pregnant dangerous, as you can experience serious complications from scar tissue in your womb. You should have a reliable, preferably permanent, form of birth control. Talk to your doctor if you have any questions.