Endometrial ablation is a procedure that surgically ablates the endometrium. The goal of endometrial ablation is to reduce menstrual flow. In some women, menstrual flow may stop completely.
No surgical incisions are required to perform this procedure. The doctor inserts thin instruments through the passage between the vagina and the uterus (cervix).
Some types of endometrial ablation can be performed in the doctor’s clinic. However, others must be performed in the operating room. Factors such as the size and condition of the uterus will help determine the most appropriate way to remove the endometrium.
Why endometrial ablation is performed?
Endometrial ablation is a treatment for heavy menstrual bleeding. Your doctor may recommend endometrial ablation if you have:
- Unusually severe menstrual periods, sometimes determined by the need to replace the sanitary pad or tampon every two hours or less
- Bleeding that lasts for more than eight days
- Anemia due to excessive blood loss
To reduce menstrual bleeding, doctors usually resort to prescribing medications or using an IUD as primary options. Endometrial ablation can be an option if other treatments did not help or if you are unable to undergo other treatments.
In general, it is not recommended to perform endometrial ablation for postmenopausal women or for women who have:
- Certain uterus abnormalities
- Uterine cancer, or an increased risk of uterine cancer
- Active pelvic inflammation
Pregnancy can occur after endometrial ablation. However, these pregnancies can have a high risk for the mother and the fetus. Pregnancy may end with miscarriage due to damage to the endometrium or may occur in the fallopian tubes or cervix rather than in the uterus (ectopic pregnancy).
Some types of sterilization procedures can be performed at the same time as endometrial ablation. If you are undergoing endometrial ablation, long-term contraceptive or sterilization is recommended to prevent pregnancy.
How to Prepare For This Procedure?
- Conduct a pregnancy screening. Endometrial ablation cannot be performed if you are pregnant.
- Check for cancer. A thin tube (catheter) is inserted through the cervix to take a small sample of the endometrium to be tested for cancer.
- Intrauterine device (IUD) removal. Endometrial ablation cannot be performed while using an IUD.
- Reducing the thickness of the endometrium. Some types of endometrial ablation surgeries are more successful when the endometrium is thin. Your doctor may prescribe medications for you or perform uterine dilation and curettage (D&C); a surgery in which the doctor scrapes and removes excess tissue.
- Discuss anesthesia options. Some methods of endometrial ablation require general anesthesia, while other types can be performed with conscious sedation or by anesthetic injection into the cervix and uterus.
How Endometrial Ablation is Performed?
Endometrial ablation can be performed in a doctor’s office. But some types of endometriosis are performed in the hospital, especially if you need general anesthesia.
Endometrial ablation procedures differ depending on the method used to remove the endometrium. Options include:
- A thin Speculum is used to see inside the uterus. A device that is passed through the scope, such as a wire loop, is heated and used to carve grooves in the endometrium. Electrosurgery requires complete anesthesia.
- Extreme cooling is used to create two or three ice balls that are frozen to destroy the endometrium. Ultrasound imaging at the time of the procedure allows the doctor to track the progress of the ice balls. Each freezing course lasts up to six minutes, and the number of cycles required depends on the size and shape of the uterus.
- Warm Liquid Injection. A warm saline fluid is injected and circulated in the uterus for 10 minutes. One advantage of this method is that it can be done in women who have an irregular uterus due to abnormal tissue growth – such as lesions inside the uterine cavity or uterine fibroids – that distort the uterus.
- Heated Balloon. A balloon device is inserted through the cervix and then inflated with hot liquid. Depending on the type of balloon device, the process can take anywhere from 2 to 10 minutes.