What's the Purpose of an Endometrial Ablation?

Endometrial ablation is a safe and effective procedure in most cases. However, it can impair fertility and also make pregnancy risky or even unfeasible.

Endometrial ablation is a surgical procedure for removing the endometrium. This lining of the uterus nourishes a fetus when pregnant under normal conditions.

The endometrium thickens every menstrual cycle due to the action of estrogen and progesterone. Furthermore, the body expels the endometrium when fertilization doesn’t occur along with blood and mucus during menstruation.

The goal of endometrial ablation is to minimize menstrual flow when it’s excessive or goes on for too long. A physician can do this procedure in their clinic.

When is an endometrial ablation necessary?

In general terms, endometrial ablation is for women with menorrhagia. This is a condition in which menstruation is abundant or lasts too long or there’s bleeding between two periods. It hinders daily tasks or causes anemia in severe cases.

One can say bleeding is excessive when a woman has to change her sanitary products (pads or tampons) every hour. Likewise, it’s lengthy if it lasts more than seven days. Thus, one of the ways to solve these problems is through endometrial ablation.

This procedure isn’t recommended for women who plan on becoming pregnant in the future, as it can impair fertility. Also, it could lead to miscarriage or high-risk pregnancy.

Endometrial ablation isn’t recommended for postmenopausal women or those with any of these problems:

• Active pelvic infection
• Uterine cancer
• Certain abnormalities in the uterus, as assessed by a physician

Prior preparation for endometrial ablation

It’s important to be well informed before undergoing endometrial ablation. Moreover, women usually have to sign a consent form before this kind of surgery as well as the following:

• The surgery cannot be performed in pregnant women
• An endometrial biopsy to rule out the presence of uterine cancer
• The removal of the intrauterine device, if present
• An endometrial thinning with medication or a dilation and curettage procedure increases the chances of success of the ablation
• There may be local or general anesthesia depending on the procedure to perform

Some medications may be counterindicated in the days leading up to the procedure. A doctor may also prescribe medication to dilate the cervix about eight to 12 hours before surgery. In addition, the woman may not be able to drink or eat for six to 12 hours before the procedure.

What’s the endometrial ablation procedure like?

There are several techniques to do an endometrial ablation. All of them aim to destroy the endometrial tissue and do so in various ways.

• Electrosurgery with a device called a resectoscope and an instrument that uses heat
• Cryoablation with an elongated probe to apply extreme cold
• Warm saline fluid introduced into the uterus for 10 minutes
• A thermal balloon inserted into the uterus, inflated and heated
• Inserting a probe that generates microwave energy
• Radiofrequency with a flexible device that emits radiofrequency energy

These techniques comprise two large groups:

• Procedures using hysteroscope
• Resectoscope and others

Accordingly, the endometrial ablation procedure takes place as follows.

Initial steps in all techniques

Firstly, the patient must wear a hospital gown. Next, the medical staff places an intravenous line in her hand or arm. The woman then lies down in the position used for a pelvic examination.

Then, the doctor inserts a speculum to separate the vaginal walls and expose the cervix and sterilize it with an antiseptic solution. Thereafter, slight variations are depending on the technique to use.

Techniques using a hysteroscope or resectoscope

The techniques using hysteroscope or resectoscope are electrosurgery, microwave, and hot fluid. The procedure in these cases happens as follows:

• Apply anesthesia
• Insert a urinary catheter if the case requires it
• Use a tenaculum, similar to forceps, to keep the cervix steady while performing the procedure
• Insert a series of rods, each larger in diameter than the previous one, to widen the opening of the cervix and introduce the hysteroscope or resectoscope
• Introduce a liquid solution or gas to fill the uterus and facilitate visualization
• Introduce the instrument or ablation substance and use it to destroy the tissue
• Pump out all of the liquid and remove the instruments

Other techniques for endometrial ablation

The other techniques are thermal balloon endometrial ablation, cryoablation, and radiofrequency. In this case, the medical staff performs the initial steps along with the following actions:

• Numb the area using a medication applied by local injection
• Introduce a uterine probe, if necessary, to establish the length of the uterus and cervical canal and then, remove it
• Depending on the case, they may insert a silicone balloon, a triangular mesh of electrodes, or a probe that produces cold temperatures
• Destroy the endometrial tissue using hot liquid in the balloon, radiofrequency energy, or intense cold, depending on the technique
• Remove the instruments

Recovery after the procedure

After the procedure, the medical staff transfers the patient to a recovery room where she’ll remain under observation for a couple of hours. Furthermore, they’ll either discharge her as soon as her vital signs stabilize, or send her to a room if necessary.

The patient may experience some of the following symptoms after endometrial ablation:

• Cramps that are similar to menstrual ones and usually last between one and two days; they may take over-the-counter analgesics to tone them down.
• A watery vaginal discharge mixed with blood, more abundant at first. It usually lasts one or two weeks.
• Frequent urination during the first 24 hours after the procedure.

A woman can go back to her normal activities after a couple of days. Moreover, they should skip sex, tampons, and douches for the next two to three days. They should also abstain from doing any strenuous physical activity for a week.

Risks and complications

Endometrial ablation is a safe procedure that rarely has complications. Any of the following conditions may occur in rare cases:

• Perforation of the uterine wall or bowel
• Thermal injury to the uterus or bowel wall
• Pulmonary edema (the accumulation of fluid in the lungs)
• Pulmonary embolism (a blockage of blood circulation within the lung)
• Tearing of the cervix
• Infection or bleeding
• Thermal injury damage to the vagina or vulva
• Allergic reaction
• Failure of endometrial ablation (the endometrium abnormally grows back after surgery)

Seek medical attention if any of the following symptoms occur after the procedure:

• Fever or chills
• Foul-smelling discharge
• Excessive pain in the area
• Excessive bleeding
• Bleeding more than two days after surgery
• Difficulty urinating

Consult your doctor to make an informed decision

Most women stop having heavy or lengthy menstruation after endometrial ablation. In addition, estimates indicate that between 30 and 50% of them stop menstruating altogether. However, this is more frequent in older women.

Finally, younger women are at greater risk of needing a second procedure. It’s important to emphasize that pregnant women or those who plan to be shouldn’t undergo an endometrial ablation. Also, it isn’t suitable for those at risk of uterine cancer.