Endometrial Ablation

Endometrial ablation at a glance

• Endometrial ablation is a medical procedure that removes or destroys the lining of the uterus (endometrium). This procedure is usually performed for women who have very long or very heavy periods that prescription medication has not been able to treat.
• After endometrial ablation, nine out of 10 women will either have no or lighter menstrual periods. However, heavy or long periods may return after several years following the procedure.
• Endometrial ablation is usually done with a small instrument called a hysteroscope. Since the nerves in the uterus cannot feel heat, cold, or electrical stimulation one of these elements will be used to eliminate the lining.
• Prior to the ablation, the patient may take medication that thins the lining. After the procedure, cramping or discomfort may occur, but most women don’t experience pain from the procedure itself.

Endometrial ablation techniques

There are several types of endometrial ablation procedures, such as balloon ablation, bipolar radiofrequency ablation, and cryoablation – all of which can be performed in an outpatient surgery center. Electrosurgery is another technique, but must be performed in a hospital.

Balloon ablation

Heat is used in this technique, which employs a flexible latex balloon that is placed into the uterus. The balloon is then filled with hot fluid until it expands enough to rest against the endometrium and destroy the lining.

Bipolar radiofrequency

A thin, wand-like probe is inserted into the uterus and turned on. It then emits short waves of energy that destroy the endometrium lining.

Cryoablation

A very small probe is inserted into the uterus and afterwards is cooled to a very low temperature in order to freeze and destroy the endometrium.

Electrosurgery

Electrosurgery endometrial ablation uses instruments that conduct an electric current, which destroys the endometrium lining. This procedure is performed in a hospital operating room, and the patient may be under full anesthesia (causing a deep sleep) or light anesthesia (causing a dreamlike wakefulness), which makes the patient unaware of discomfort or pain. The doctor inserts the hysteroscope through the vagina and cervix into the uterus in order to correctly place the electric tools in the desired position.

Endometrial ablation risks

A few serious, though unlikely, injuries can occur during endometrial ablation, such as:

• The devices used could puncture the uterus, causing bleeding or damage to organs near the uterus, such as the bowel, bladder, or blood vessels.
• The fluids used for some of the ablation techniques could leak and cause burns.
• The fluid used for electrosurgery can cause an electrolyte imbalance.

In addition, some studies have shown that, in rare circumstances, it is more difficult to diagnose uterine cancer after endometrial ablation. Because of this, post-menopausal women on hormone therapy must also take progesterone (also called progestogen or progestin) to reduce the risk of uterine cancer.

Fertility after endometrial ablation

Endometrial ablation makes pregnancy less likely, but not impossible. The procedure removes only the lining, leaving the uterus intact. The chance of pregnancy occurring after endometrial ablation is extremely small, but if a woman does not want to get pregnant, the doctor will usually prescribe a form of birth control.

When not to have endometrial ablation

Women who are pregnant, who would like to have children in the future, or have gone through menopause should not have this procedure. Non-cancerous or pre-cancerous growths cannot be treated with endometrial ablation.