Endometrial Ablation Procedure
Overview
Endometrial ablation treats heavy menstrual bleeding by removing or destroying the endometrial lining of the uterus, which can reduce or sometimes completely stop menstrual flow. Different methods avoid major surgery and do not require traditional incisions.
Providers insert tools through the vagina and cervix to reach the uterus. The choice of technique often depends on a person’s health, the shape and size of the uterus, and the medical provider’s experience. One common method uses radiofrequency energy to treat the uterine lining.
| Method | How It Works |
|---|---|
| Radiofrequency Ablation | Radiofrequency energy |
| Cryoablation | Extreme cold |
| Thermal Balloon | Heated fluid |
| Microwave | Microwave energy |
Reasons for Endometrial Ablation
Providers use endometrial ablation when someone faces significant problems with menstrual bleeding. People who have very heavy periods—sometimes soaking a pad or tampon every two hours or less—or bleeding that continues for more than eight days may choose this treatment.
Heavy bleeding can lead to anemia, making a person feel tired or weak because of low red blood cell counts. Providers consider this treatment when other options, like birth control pills or an IUD, do not control the bleeding. Common reasons for endometrial ablation include:
- Menorrhagia (very heavy periods)
- Abnormal uterine bleeding
- Anemia from excessive bleeding
- Avoiding hysterectomy (surgical removal of the uterus)
Providers most often recommend it for premenopausal women who do not plan future pregnancies. They do not usually advise it for those who are past menopause, have certain uterine problems, cancer or infection, or wish to have children later.
Potential Risks
Endometrial ablation may lead to several risks and side effects. Possible problems include:
- Infection: Bacteria can get into the uterus.
- Bleeding: Some people may have heavy bleeding after the procedure.
- Pain or Cramps: Many feel pain or stomach cramps during recovery.
- Injury to Organs: Rarely, heat or cold from the procedure can damage organs near the uterus, or the tools may puncture the wall of the uterus.
- Other Effects: Nausea and risk of blood clots may also occur but are not frequent.
- Adverse Events: Difficult recovery or unwanted side effects can also happen.
Long-Term Impact on Getting Pregnant
Pregnancy is still possible after endometrial ablation but carries serious risks. The uterus may not support the pregnancy well, which can lead to miscarriage or problems with the placenta attaching. There is also a higher chance of ectopic pregnancy, where the embryo grows outside the uterus.
Because of these dangers, providers strongly recommend permanent or long-term birth control after the procedure to prevent pregnancy. No evidence links the procedure directly with uterine cancer.
Getting Ready for the Procedure
A gynecologist guides patients through several important steps before the procedure. In the weeks leading up to it, they check for pregnancy, since this type of treatment cannot be done if someone is expecting.
The healthcare provider may run tests to check for any signs of cancer by collecting and examining a small tissue sample from the uterus. The doctor also examines the uterus more closely—often using an ultrasound to look at the shape and size, or a thin, lighted device to see inside the uterus (hysteroscopy).
If the person has an intrauterine device (IUD), the provider removes it before the procedure. Another step involves making the uterine lining thinner. The doctor may suggest medicines for this or may use a special tool to gently remove some tissue.
The gynecologist discusses pain relief options, which could be numbing shots or stronger medicine to help the person feel comfortable. In some cases, general anesthesia is used. Patients should follow all instructions from their gynecologist to be ready for the procedure day.
Checklist for Preparation
| Step | Details |
|---|---|
| Pregnancy Test | Required before the procedure. |
| Cancer Check | Uterine tissue sample checked for safety. |
| Uterine Exam | Imaging and/or hysteroscopy may be done. |
| Remove IUD | If present, the IUD must be taken out. |
| Thin Lining | Medicine or a tool may be used. |
| Discuss Anesthesia | Pain management methods are reviewed. |
What You Can Expect
What Happens While the Procedure Takes Place
Providers perform endometrial ablation in a clinic or an operating room. Before starting, the doctor may widen the opening of the cervix, a process known as cervical dilation. Once inside, the provider carries out the chosen method to treat the endometrial lining, based on earlier evaluations. Each technique works differently:
| Type of Ablation | How it Works | Notes |
|---|---|---|
| Cryotherapy | A cold probe freezes sections of the uterine lining. | Uses ultrasound guidance; takes about 6 minutes per freeze cycle. |
| Hydrothermal Ablation | Heated fluid is placed inside the uterus to damage the lining. | Can treat an irregular-shaped uterus due to growths or fibroids. |
| Radiofrequency Ablation | A triangular device sends radio waves to destroy the lining in just 1–2 minutes. | The device is removed after treatment. |
| Electrocautery Ablation | Electric current is applied through a scope and special tool to burn the lining. | Often done under general anesthesia; used less frequently. |
| Microwave Ablation | A device uses microwave energy to remove the uterine lining. | Newer devices are currently being developed. |
Most ablation procedures are minor surgeries, and providers perform them as outpatient procedures. The patient might be awake with local anesthesia or asleep under general anesthesia, depending on the method and provider. In some cases, a hysteroscopy allows the provider to see inside the uterus, guiding the tools more precisely.
What Could Happen After the Procedure
Many people have mild to moderate cramps, similar to a menstrual period, for a few days after the procedure. Over-the-counter medications, such as ibuprofen or acetaminophen, usually help with this discomfort.
A watery or sometimes bloody vaginal discharge often occurs and can last up to several weeks. This discharge is generally heavier in the first few days, then slowly decreases. Some people need to pass urine more often, especially in the first 24 hours. This is usually temporary and goes away as the body heals.
Providers advise patients about when it is safe to return to normal activities, like work, exercise, and sexual activity. Recovery time depends on the ablation method and the individual, but most people are back to regular daily routines quickly.
A follow-up check with the healthcare provider is routine after ablation. At this visit, the provider will assess how the uterus is recovering and answer any questions about symptoms or next steps. If there are any concerns, such as unusual pain or continued heavy bleeding, patients should contact their provider right away.
Findings
After endometrial ablation, many patients notice a decrease in menstrual bleeding within a few months. Some people report much lighter periods, while others may stop having periods altogether.
| Approach | Common Outcome |
|---|---|
| Radiofrequency Ablation | Less bleeding, light or no periods |
| Cryoablation | Reduced periods |
| Microwave | Lighter periods |
