Endometrial Ablation

What is endometrial ablation?

Endometrial ablation is a procedure that uses heat, cold or different types of energy to destroy the lining of your uterus (endometrium). Your healthcare provider may recommend an endometrial ablation as an option to treat heavy menstrual bleeding. After an endometrial ablation, you may have no bleeding, less bleeding or no change in how much you bleed during your periods.

What is considered a heavy period?

Periods are considered heavy if they:

• Cause symptoms of anemia, like fatigue and feeling cold
• Last more than a week
• Cause you to change a pad or tampon every hour for several hours in a row
• Keep you from going to work or school or attend social events

What conditions does endometrial ablation treat?

Endometrial ablation treats heavy menstrual bleeding when medications don’t help. You may be a candidate for endometrial ablation if:

• You’re sure you don’t want to get pregnant in the future. Pregnancy after the procedure is unlikely, but it can happen. If it does, there are risks of miscarriage and other complications. You should also use birth control until menopause to avoid the chances of getting pregnant.
• Your healthcare provider doesn’t find a cause for your heavy periods, like cancer or thyroid disease.

What happens before endometrial ablation?

Your healthcare provider will make sure that endometrial ablation is the right procedure to reduce your uterine bleeding. Before performing an endometrial ablation, they may do all of the following:

• You’ll take a pregnancy test. You can’t be pregnant during an endometrial ablation. If you have an intrauterine device (IUD), your provider will remove it.
• Your provider may do a biopsy to look for abnormal cells in your uterus and make sure you don’t have cancer.
• Your provider will check what medicines you’re taking. You’ll want to be sure that you’re not taking medicine that could cause problems during the procedure (for example, if you’re taking a blood thinner).
• Your provider will order an ultrasound or hysteroscopy to take a closer look at your uterus.
• Depending on the type of endometrial ablation, you may take medicine that thins your uterine lining.

Your provider will go over other instructions to prepare you for surgery. This could involve information about when to stop eating and drinking (if applicable) before the procedure or if you’ll need someone to drive you home after surgery. There are different methods your provider uses during an endometrial ablation, and the instructions for each can vary.

What happens during endometrial ablation?

You can have an endometrial ablation in your provider’s office or a surgical center. You’ll situate yourself on an exam table as if you’re having a pelvic exam. Your provider may give you medicine about an hour before the endometrial ablation to help manage any discomfort after the procedure. Depending on the type of endometrial ablation, your provider may numb your pelvic area and give you sedatives so you don’t feel any pain or discomfort.

During endometrial ablation, your healthcare provider inserts a delicate, wand-like device into your vagina. This device goes through your cervix and into your uterus, where it can reach the lining. Depending on the type of endometrial ablation, the device sends energy, heat or cold to destroy part of the lining. The technology makes things quick, and it’ll be over before you know it.

What are the types of endometrial ablation?

There are different types of endometrial ablation, but they all involve destroying the lining of your uterus:

• Microwave. Your provider places a small applicator into your vagina. The applicator releases a microwave energy that heats the lining of your uterus, destroying parts of it. The process takes from three to five minutes.
• Radiofrequency. Your provider inserts a wand-like instrument with a mesh tip inside your vagina. One inside, it expands inside your uterus, just enough so radiofrequency energy can reach the lining and destroy it. The process takes from one to two minutes.
• Electricity (electrosurgery). Your provider inserts a small, tube-like device with a viewing lens (resectoscope) into your vagina. The tube-like device is fitted with a wire loop, roller ball or laser that releases electricity. The electricity destroys parts of your uterine lining. The viewing lens helps your provider see inside your uterus and monitor the electrical currents as they turn parts of the lining into scar tissue. This type of ablation is the least common and may require you to have general anesthesia.
• Heated fluid (hydrothermal). Your provider uses a hysteroscope (thin, lighted tube) to move hot water vapor into your uterus. The vapor is warm enough to destroy your uterine lining. The process takes about 10 minutes.
• Heated balloon (balloon therapy). Your provider places a tiny balloon into a thin tube (catheter). Hot fluid flows through the tube and into the balloon, filling it up. The hot balloon presses against your uterine lining. The heat from the balloon destroys any lining that it touches. The process takes from two to 10 minutes.
• Cold (cryoblation). Your provider uses a tube with a cold tip to create tiny ice balls that freeze parts of your uterine lining, destroying it. The process takes about 10 minutes.

Are you put to sleep for an endometrial ablation?

No. In most cases, general anesthesia (or being asleep) isn’t necessary for an endometrial ablation. Your healthcare provider can go over your options for pain relief during and after an endometrial ablation.

How painful is endometrial ablation?

You may feel discomfort and light cramping during the procedure, but your healthcare provider will do what they can to keep you comfortable.

How long does an endometrial ablation take?

Endometrial ablation is relatively quick. Depending on the method your provider uses, you can expect the procedure to last anywhere between three and 10 minutes.

What happens after endometrial ablation?

Pay close attention to your body. You’ll probably notice some changes after you’ve had an endometrial ablation. These are normal side effects and not a cause for worry:

• You may feel a little nauseated.
• You may have to pee more on the first day after the procedure.
• You may have period-like cramps for one to three days after.
• You may have light bleeding or pink, watery discharge for a few weeks. It’s usually heaviest 48 to 72 hours after the procedure.

Your healthcare provider will go over specific aftercare instructions with you. In most cases, they’ll ask you to avoid sex and using tampons for a few days. Most people are back to their usual activities within 48 hours.

What are the benefits of endometrial ablation?

Endometrial ablation is a safe procedure that can stop heavy menstrual bleeding without having to take medicine every day. It’s also less risky than a hysterectomy, which removes your uterus entirely.

It may take several months to see the benefits of endometrial ablation. You’ll have follow-up appointments with your provider to monitor how you’re progressing.

What are the risks of endometrial ablation?

Although it’s safe, there are risks to endometrial ablation. They include:

• Heavy bleeding
• An allergic reaction
• Infection
• Puncturing or burning your uterus
• Harming organs near your uterus like your large intestine

Who should not have endometrial ablation?

Endometrial ablation isn’t for everyone. Your healthcare provider will evaluate your bleeding and determine if endometrial ablation is an option for you. Some reasons you may not be able to have it are:

• You’re in post-menopause. After menopause, the risks of developing endometrial cancer increase. Destroying endometrial tissue makes it harder to find cancer cells in your uterus.
• You or your partner don’t have permanent birth control (tubal ligation or vasectomy) or you aren’t willing to use birth control after the procedure.
• You have a uterine infection or other a condition like uterine fibroids or endometrial hyperplasia.
• You have uterine cancer.

How will endometrial ablation affect my periods?

Your periods will probably be lighter than they were before. Or you may no longer have a period. Be sure to monitor how heavy your periods are and how regularly they occur. Remember, it can take several months to know the full effects of an endometrial ablation.

How will endometrial ablation affect future pregnancy?

Getting pregnant is dangerous after an endometrial ablation. You’ll still ovulate and have uterine lining remaining, which means you can get pregnant. Following endometrial ablation, you have a higher chance of a miscarriage or dangerous complications during pregnancy. This is why it’s so important to use birth control after the procedure. Some people choose to have a tubal ligation when they have an endometrial ablation.

What is the recovery time?

You should feel like your normal self within two to three days, and you should be able to carry on with your routine. Within two to three months, you’ll notice that your periods are lighter. You may even stop having periods altogether.

Are periods worse after endometrial ablation?

Not usually. In most cases, people see a positive improvement in their menstrual bleeding after endometrial ablation.

When should I see my healthcare provider?

Make sure to keep any appointments your provider recommends after your endometrial ablation. Call your provider if you have symptoms like:

• Fever
• Trouble peeing
• Intense cramping
• Heavy bleeding, like if you’re using more than one pad per hour for several hours
• Foul-smelling discharge from your vagina

If you’re still having heavy periods after three months, make an appointment with your healthcare provider to check on your recovery.