What is an Endometrial Ablation?

This is a procedure which surgically destroys the uterine lining (endometrium). The aim of endometrial ablation is to minimize menstrual flow. No incision is required for this procedure. A light viewing hysteroscope is inserted through the channels between the vagina and cervix. The procedure may be carried out using:

• Laser beam or thermal ablation
• Thermal or heat ablation, using:
  • Heated free liquid or normal saline
  • High-energy radio frequencies
  • Thermal balloon ablation which is kindled to 185°F / 85°C
• Microwave energy
• Freezing
• Electricity by use of resectoscope with a rolling ball electrode or loop

Endometrium heal by scarring, which generally minimizes or inhibits uterine bleeding.

 

How is the procedure performed?

Before the procedure is performed, a biopsy (endometrial sampling) needs to be performed to eliminate the existence of cancer. Direct visualization or imaging studies using a hysteroscope are necessary to eliminate the existence of benign tumors or uterine polyps under the lining muscles of your uterus. Polyps and fibroids (benign tumors) are likely reasons of too much bleeding that may be simply detached, leaving ablation of your whole uterine lining. Evidently, the likelihood of pregnancy need be debarred while IUDs (intrauterine contraceptive devices) need be removed before the procedure.    

Hormonal therapy might be given weeks before endometrial ablation (in young women especially), so as to shrink the uterine lining to a magnitude where ablation remedy has the greatest probability for success. The thinner the uterine lining, the higher the probabilities for efficacious ablation.        

The procedure begins by dilating the cervical opening to allow instruments to pass to the uterine cavity. Other procedures that have been implemented for effectively destroying the endometrium tissue include heating, freezing, laser beam, and electricity.

The following factors influence the procedure option picked.

• Your surgeon’s experience and preference.
• The existence of fibroids, as well as the shape and size of your uterus.
• Whether or not pre-treatment is given.
• Which form of anesthesia the patient prefers. 

   

The form of anesthesia needed is determined by the method used. Minimal anesthesia might be used. Certain endometrial ablation might be carried out in the doctor’s office, while others must be done in the operating room.    

 

Why is the procedure done?

It treats excessive loss of menstrual blood. The doctor may suggest endometrial ablation when you have:

• Abnormally heavy periods. Soaking a tampon or pad in 2 hours or less.
• Bleeding which lasts for more than 8 days.
• Anemia due to excessive bleeding.

To minimize menstrual bleeding, an intrauterine device or medication can be prescribed by your doctor. If other treatments don’t work or you are not able to undergo other therapies, endometrial ablation can be used instead.

Endometrial ablation normally isn't suggested for postmenopausal women and women with:

• Certain uterus abnormalities
• Uterus cancer or uterine cancer threat
• An active pelvic contamination

 

What to Anticipate After Surgery

After the surgery, you can have certain side effects, i.e. nausea, vaginal discharge, and cramping, which can be watery with blood presence. This discharge becomes clear after some days but may last for one to two weeks.

You may go home on the same day and recover within one to two weeks.

 

How Well Does It Work?

Many women will experience minimized menstrual flow, and half will cease having periods.

Older women respond better to endometrial ablation than younger women. A repeat procedure will be required on younger women, as they continue having periods.

One to three months prior to your procedure, you can be treated using gonadotropin-releasing hormone analogues. This will minimize estrogen production to help with the endometrium thinning.

 

Risks

Problems that are likely to happen during the procedure include:

• Accidental perforation or puncture of the uterus.
• Thermal injury to your uterus or bowel surface.
• Fluid buildup in the lungs (pulmonary edema).
• Abrupt jam of arterial blood circulation within your lung (pulmonary embolism).
• Ripping of the introductory of your uterus (cervical laceration).

These issues are rare but may be severe.

 

Future fertility

Pregnancy may occur after the procedure. However, these pregnancies may be a threat to the mother and child. The pregnancy may lead to miscarriage due to damage of your uterus lining. The pregnancy may happen in the cervix or fallopian tubes instead of your uterus; this is also known as an ectopic pregnancy.

Certain forms of sterilization techniques can be used in the procedure. If you will have the procedure, sterilization or lasting contraception is suggested to avoid pregnancy.

 

How to Prepare

Weeks prior to the procedure, your surgeon may:

• Do a pregnancy test.
• Inspect for cancer by inserting a catheter through the cervix to get a minor sample of the uterine lining for testing.
• Eliminate an intrauterine contraceptive device.  
• Thin your uterine lining. Some procedures are more successful if your endometrium is thin. Medication may be prescribed, or a dilation and curettage may be performed. Your doctor scrapes away the additional tissue during this procedure. 
• Certain approaches of endometrial ablation need general anesthesia. Other forms may be done using conscious sedation or by numbing the uterus and cervix.  

 

What you may expect

During the procedure

The procedure may be carried out in your doctor's office. Other forms are done in the hospital, especially when you are going to necessitate general anesthesia.

Your cervix opening requires widening to pass instruments used in the procedure. Medication or insertion of various rods to gradually increase the cervix diameter will be needed.

Endometrial ablation techniques differ by the process used to eliminate the endometrium. Options comprise of:

• Electrosurgery – A slim scope is normally used to view inside the uterus. A tool passed through this scope, i.e. a wire loop, is heated to sculpt grooves in the uterine lining. Electrosurgery requires general anesthesia.
• Cryoablation - Extreme cold is normally used to make 2 or 3 ice balls, which freeze and destroy the endometrium. Real-time ultrasound enables your doctor to track the advancement of these ice balls. Every freeze cycle lasts for six minutes, and the shape and size of the uterus determines the required cycles.  
• Free-flowing hot liquid - Heated saline liquid is circulated within your uterus for almost 10 minutes. The advantages of this procedure is it can be carried out in women who have irregularly shaped uteri due to abnormal tissue development, i.e. uterine fibroids or intractivity lesions, which cause uterus distortion.
• Heated balloon - A balloon instrument is injected through the cervix and inflated using heated fluid. The process may take 2 to 10 minutes, depending on which type of balloon is used.
• Microwave - A slim wand is injected through your cervix. The wand radiates microwaves that heat your endometrial tissue. Treatment generally lasts 3 to 5 minutes.
• Radio frequency - A special tool unfurls a stretchy ablation device into your uterus. The device passes on radio frequency energy, which evaporates all endometrial tissue, after which it is removed.

After your procedure

After your procedure you may experience:

• Cramps - Menstrual-like cramps can be experienced for a couple days. Over-the-counter drugs, i.e. acetaminophen or ibuprofen, are recommended.
• Vaginal discharge - Watery discharge with blood presence may occur for a couple of weeks.
• Frequent urination – This normally happens during the first twenty-four hours after the procedure.

 

Endometrial ablation outlook.

Most women report successful decrease of abnormal bleeding. Half the women will cease having periods. 

This procedure shouldn’t be seen as a contraceptive measure, since pregnancy may still happen to a small ration of your endometrium that has regrown or remained. Such a case can have severe issues with your pregnancy and endometrial ablation and can never be done if a woman should desire to have children in her future.