Endometrial ablation is a procedure designed to destroy the uterine lining (endometrium).
The doctor may recommend this procedure if one’s menstrual periods are extremely heavy and can’t be controlled with medication. Doctors consider menstrual flow to be too heavy if one’s tampon or sanitary pad is routinely soaked through within two hours.
They may also recommend this procedure if the patient experience:
Endometrial ablation is a permanent procedure. The patient’s uterine lining won’t grow back afterward. This procedure is helpful for many women but isn’t recommended for everyone. Talk to the doctor about whether this is the best option for the patient.
How to prepare
Prior to scheduling, the patient discusses his medical history and any allergies he is having with the doctor.
If the patient and his doctor decide to move forward with the procedure, they’ll discuss all aspects of the procedure with the patient ahead of time. This includes what the patient should and shouldn’t do in the days and weeks leading up to it.
Standard pre-procedure protocols include:
The patient may need to have his uterine lining thinned beforehand in order to make the procedure more effective. This may be done with medication or with a dilation and curettage (D and C) procedure.
Not all endometrial ablation procedures require anesthesia. If general anesthesia is needed, the patient will be instructed to stop eating and drinking eight hours before the procedure.
Additional pre-surgery tests, such as an electrocardiogram, may also be done.
How the procedure is done
In an endometrial ablation, the doctor first inserts a slender instrument through the patient’s cervix and into her uterus. This widens the patient’s cervix and allows the doctor to perform the procedure.
This can be done in one of several ways. The doctor’s training and preferences will direct which of the following they will use:
Freezing (cryoablation): The doctor places an ultrasound monitor on the patient’s abdomen to help them guide the probe. The size and shape of the patient’s uterus determines how long this procedure lasts.
Heated balloon: A balloon is inserted into the patient’s uterus, inflated, and filled with hot fluid. The heat destroys the uterine lining. This procedure typically lasts from 2 to 12 minutes.
Heated free-flowing fluid: Heated saline liquid is allowed to flow freely throughout the patient’s uterus for around 10 minutes, destroying the uterine tissue. This procedure is used in women with irregularly shaped uterine cavities.
Radiofrequency: A flexible device with a mesh tip is placed into the patient’s uterus. It emits radiofrequency energy to eliminate uterine tissue in one to two minutes.
Microwave: An inserted probe uses microwave energy to destroy the patient’s uterine lining. This procedure takes three to five minutes to complete.
Electrosurgery: This procedure requires general anesthesia. It uses a telescopic device called a resectoscope and a heated instrument to see and remove uterine tissue.
What to expect after the procedure
The type of procedure the patient has will determine, in part, the post-procedure care and length of recuperation. If the patient needs general anesthesia, then the doctor will have the patient remain in the hospital for several hours after surgery.
No matter what type of procedure the patient undergoes, he will need someone to take him home afterwards. The patient should also bring a sanitary napkin with her to wear after the procedure is completed. Talk to the doctor about over-the-counter medication to take for cramps or nausea, and which one is to be avoided.
After the procedure, the patient may experience:
- increased urination for about a day
- menstrual-type cramping for several days
- watery, bloody vaginal discharge for several weeks
The patient should seek emergency medical attention if she experiences:
Risks and complications
Women are advised to continue using birth control after having an endometrial ablation. If pregnancy does occur, it’s likely to result in miscarriage.
Normally, the endometrial lining thickens in response to pregnancy. Without a thick endometrial lining, an embryo can’t implant and grow successfully. For this reason, the doctor may recommend sterilization as an additional procedure.
Apart from the very real risk to your fertility, complications from this procedure are rare. These rare risks can include:
- puncturing of the patient’s uterine wall or bowels
- postsurgical infection or bleeding
- damage to the patient’s vagina, vulva, or bowels from the hot or cold applications used during the procedure
- absorption of the fluid used during the procedure into the patient’s bloodstream