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Endometrial Ablation

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Endometrial Ablation

Definition

This procedure involves the surgical removal of the lining of the uterus (womb). It may involve using heat, cold temperatures, microwave energy, or other methods.

Reasons for Procedure

Endometrial ablation will likely make menstrual flow lighter. In some cases, it stops menstrual flow completely. The procedure is used to treat menorrhagia (recurrent heavy periods not controlled by medicine).
Talk to your doctor about your plans for having a baby. This procedure decreases your chance of pregnancy.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have endometrial ablation, your doctor will review a list of possible complications, which may include:
  • Infection
  • Bleeding
  • Complications related to anesthesia
  • Uterine perforation or organ injury
  • Edema (swelling) due to fluid leakage and absorption
  • Thermal (heat) injury to the vagina, vulva, or bowel
Some factors that may increase the risk of complications include:
  • Pregnancy or possible pregnancy—procedure should not be done if there is a chance that you are pregnant
  • History of pelvic inflammatory disease (PID)—may trigger a recurrence of PID
  • Inflammation of the cervix
  • Being overweight or obese
  • Smoking
Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure

Prior to the procedure, your doctor will likely:
  • Do an endometrial biopsy , ultrasound , or hysteroscopy of your uterus to check for abnormalities and understand the shape and size of your uterus.
  • Ask about:
    • Your medical history
    • Medicines or herbs and supplements you take
    • Any allergies you have
    • Whether you are pregnant or trying to get pregnant
    • If you have an intrauterine device (IUD)
Before the procedure, you may need to:
  • Ask your doctor about your options. There are many types of endometrial ablation.
  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs (eg, aspirin )
    • Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
  • Take medicine to thin the lining of the uterus.
  • Arrange for someone to drive you home from the care center. You may also need help at home.
  • Try to quit smoking.
The day before the procedure:
  • Have a light dinner.
  • The night before, do not eat or drink anything after midnight.

Anesthesia

There are three anesthesia options for ablation:
  • General anesthesia —blocks pain and keeps you asleep through the procedure
  • Regional anesthesia —blocks pain in an area of the body but you stay awake through the procedure, given as an injection
  • Local anesthesia—just the area that is being operated on is numbed, given as an injection
Your doctor will help you decide which one is right for you.

Description of the Procedure

There are many different ways for the doctor to do this procedure. A simple ablation procedure is short. It can often be done in a care center. Other procedures take longer and need to be done in a hospital.
During the procedure, the doctor will not make any incisions to access the uterus. A tiny probe will be inserted through the vagina and into the uterine cavity through the cervix. Depending on the method, the tip of the probe will expand to deliver:
  • Radiofrequency (heat and energy)
  • Cryoablation (freezing temperature)
  • Heated fluid
  • Heated balloon
  • Microwave energy
  • Electrosurgery (uses electrical current and a heated rollerball or spiked ball)—may require general anesthesia
These methods will destroy the cells lining the uterine cavity. You will not feel pain. Often, ultrasound is used to help guide the doctor. Suction will be used to remove the tissue that has been destroyed.

How Long Will It Take?

This depends on the type of method. It can take 15-45 minutes or longer.

How Much Will It Hurt?

You may feel cramping and discomfort. Your doctor will give you pain medicine.

Average Hospital Stay

This is usually done on an outpatient basis. You may need to stay there for 1-2 hours. Some methods may require an overnight hospital stay.

Post-procedure Care

At the Care Center or Hospital
While recovering, you may receive the following care:
  • Check blood pressure, heart rate, and breathing
  • Check on your fluid status and the electrolytes in your blood
Your doctor will ask you how you feel and make sure you are well enough to go home.
At Home
After the procedure, you may:
  • Feel cramping for 1-2 days
  • Have a heavy discharge for 2-3 days
  • Have a watery, bloody discharge for a few weeks
  • Need to go to the bathroom a lot for the first day and have some nausea
When you return home, do the following to help ensure a smooth recovery:
  • Make sure you have a supply of sanitary pads at home.
  • You should be able to return to normal activities within a day or two. Ask your doctor when you can:
    • Exercise
    • Resume sexual activity
    • Use tampons
    • Shower, bathe, or soak in water
  • Since you still have your sexual organs, you will need to:
    • Use birth control to prevent pregnancy
    • Have routine Pap tests
    • Have pelvic exams

Call Your Doctor

After you leave the hospital, call your doctor if any of the following occurs:
  • Heavy vaginal bleeding
  • Severe abdominal cramping and pelvic pain
  • Severe pain during sex
  • Severe low back pain
  • Pain during bowel movements or urination
  • Signs of infection, including fever and chills
  • Nausea and vomiting
  • Cough, chest pain, or shortness of breath
  • Dizziness or lightheadedness
  • Pain or tenderness in the calf or leg
  • Menstruation does not get lighter after 2-3 periods
In case of an emergency, call for medical help right away.

RESOURCES

The American Congress of Obstetricians and Gynecologists http://www.acog.org/

American Society for Reproductive Medicine http://www.asrm.org/

CANADIAN RESOURCES

Canadian Women’s Health Network http://www.cwhn.ca/

Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org/

References

Badash M. Menorrhagia. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 17, 2008. Accessed April 7, 2009.

Endometrial ablation. AHRQ National Guideline Clearinghouse website. Available at: http://www.guideline.gov/summary/summary.aspx?doc%5Fid=10918&nbr=5698&ss=6&xl=999 . Updated May 2007. Accessed April 7, 2009.

Endometrial Ablation. The American College of Obstetricians and Gynecologists, Practice bulletin. No. 81, May 2007. Obstet Gynecol. 2007 May;109(5):1233-48.

Endometrial ablation. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/publications/patient%5Feducation/bp134.cfm . Published March 2009. Accessed May 4, 2009.

Heavy menstrual bleeding. National Institute for Health and Clinical Excellence website. Available at: http://www.nice.org.uk/nicemedia/pdf/CG44NICEGuideline.pdf . Published January 2007. Accessed April 7, 2009.

Lethaby A, Hickey M, Garry R. Endometrial destruction techniques for heavy menstrual bleeding. Cochrane Collection website. Available at: http://www.cochrane.org/reviews/en/ab001501.html . Updated August 23, 2005. Accessed April 7, 2009.

Patient fact sheet: endometrial ablation. American Society for Reproductive Medicine website. Available at: http://www.asrm.org/Patients/FactSheets/endoablation.pdf . Updated 2008. Accessed May 4, 2009.

Rymaruk J. Hysteroscopy. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 17, 2008. Accessed April 7, 2009.

Understand NICE guidelines: treatment and care for women with heavy periods. National Institute for Health and Clinical Excellence website. Available at: http://www.nice.org.uk/nicemedia/pdf/HMBUNGv9Sept08.pdf . Published January 2007. Accessed April 8, 2009.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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