Endometrial Ablation

What is an endometrial ablation?

Endometrial ablation is a procedure to remove a thin layer of tissue (endometrium) that lines the uterus. It's done to stop or reduce heavy menstrual bleeding. But it's only done on women who don't plan to have any children in the future.

You will not have any cut (incision). Instead your healthcare provider puts small tools through your vagina to reach your uterus. Your provider has several ways to do the procedure. They can use:

• Electricity (electrical or electrocautery). In this method, your provider uses an electric current that travels through a wire loop or roller ball to destroy it.

• Fluids (hydrothermal). This method uses heated fluid. It's pumped into the uterus to destroy the lining.

• Balloon therapy. Your healthcare provider puts a thin tube (catheter) into the uterus. The catheter has a balloon at the end. Your provider fills the balloon with fluid and heats it. The heated fluid destroys the lining.

• High-energy radio waves (radiofrequency ablation). In this method, your provider puts an electrical mesh into the uterus and then expands it. Then an electrical current made by radio waves is used to destroy the lining.

• Cold (cryoablation). Your provider uses a probe with very cold temperature to freeze the lining.

• Microwaves (microwave ablation). Your provider sends microwave energy through a thin probe to destroy the lining.

Some endometrial ablations are done using a tool called a hysteroscope. This tool lets your provider see the inside of your uterus. They can use a camera on the tool to record what is seen.

Why might I need an endometrial ablation?

You may decide to have endometrial ablation if you have heavy or long periods. You may also have it for bleeding between periods (abnormal uterine bleeding). In some cases, the bleeding may be so heavy that it affects your daily activities and causes a low blood count (anemia).

Heavy bleeding is described as bleeding that needs changing sanitary pads or tampons every hour. Long periods are described as lasting longer than 7 days.

Menstrual bleeding problems may be caused by hormone problems. This is especially true for women nearing menopause or after menopause. Other causes include abnormal tissues such as fibroids, polyps, or cancer of the endometrium or uterus.

Endometrial ablation lessens menstrual bleeding or stops it completely. You may not be able to get pregnant after endometrial ablation. This is because the endometrial lining, where the egg implants after being fertilized, has been destroyed or removed. Pregnancies that occur after an endometrial ablation may have problems, therefore it's important to use a reliable form of birth control. You will still have your reproductive organs.

Your healthcare provider may have other reasons to suggest endometrial ablation.

What are the risks of an endometrial ablation?

Possible complications of endometrial ablation include:

• Bleeding

• Infection

• Tearing of the uterine wall or bowel

• Overloading of fluid into the bloodstream

Tell your healthcare provider if you are:

• Allergic to or sensitive to medicines, iodine, or latex

• Pregnant or think you could be. Endometrial ablation during pregnancy may lead to miscarriage.

You may have other risks based on your condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

You may not be able to have an endometrial ablation if you have:

• Vaginal or cervical infection

• Pelvic inflammatory disease

• Cervical, endometrial, or uterine cancer

• Recent pregnancy

• Weakness of the uterine muscle wall

• Intrauterine device (IUD)

• Past uterine surgery for fibroids 

• Classic or vertical C-section incision

• Abnormal structure or shape of the uterus 

Certain things can make it harder to do certain types of endometrial ablation. These include:

• Narrowing of the inside of the cervix

• Short length or large size of uterus

How do I get ready for an endometrial ablation?

• Your healthcare provider will explain the procedure to you. Ask any questions you have about the procedure.

• You may be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is unclear.

• You will be asked to stop eating and drinking (fast) for 8 hours before the test. This usually means after midnight.

• Tell your provider if you are pregnant or think you could be.

• Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, tape, or anesthetic drugs (local and general).

• Tell your provider about all medicines you are taking. This includes prescriptions, over-the-counter medicines, and herbal supplements.

• Tell your healthcare provider if you have had a bleeding disorder. Also tell your provider if you are taking blood-thinning medicine (anticoagulant), aspirin, or other medicines that affect blood clotting. You may need to stop these medicines before the procedure.

• Your healthcare provider may prescribe medicines to help thin the endometrial tissues to get ready for the procedure. You may need to take the medicines for several weeks before the procedure.

• You may be given medicine to help you relax. Because the medicine may make you sleepy, you will need to have someone to drive you home.

• You may want to bring a sanitary pad to wear home after the procedure.

• Follow any other instructions your provider gives you to get ready.

What happens during an endometrial ablation?

You may have an endometrial ablation in your healthcare provider's office, as an outpatient, or during a hospital stay. The way the test is done may vary depending on your condition and your healthcare provider's practices.

The type of anesthesia will depend on the procedure being done. It may be done while you are asleep under general anesthesia. Or it may be done while you are awake under spinal or epidural anesthesia. If spinal or epidural anesthesia is used, you will have no feeling from your waist down. The anesthesiologist will watch your heart rate, blood pressure, breathing, and blood oxygen level during the procedure.

Generally, an endometrial ablation follows this process:

What happens after an endometrial ablation?

The recovery process will vary, depending on what type of ablation you had and the type of anesthesia used.

If you had spinal, epidural or general anesthesia, you will be taken to the recovery room. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or sent home. If you had the procedure as an outpatient, plan to have someone else drive you home.

If you did not get anesthesia, you will need to rest for about 2 hours before going home.

You may want to wear a sanitary pad for bleeding. It's normal to have vaginal bleeding for a few days after the procedure. You may also have a watery-bloody discharge for several weeks.

You may have strong cramping, nausea, vomiting, or the need to urinate often for the first few days after the procedure. Cramping may continue for a longer time.

Don't douche, use tampons, or have sex for 2 to 3 days after an endometrial ablation, or as advised by your healthcare provider.

You may also have other limits on your activity. These may include no strenuous activity or heavy lifting.

You may go back to your normal diet unless your healthcare provider tells you otherwise.

Take a pain reliever for cramping or soreness as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding and should not be taken. Be sure to take only recommended medicines.

Your healthcare provider will tell you when to return for more treatment or care.

Tell your healthcare provider if any of these occur:

• Foul-smelling drainage from your vagina

• Fever or chills

• Severe abdominal pain

• Heavy bleeding, or heavy bleeding longer than 2 days after the procedure

• Trouble urinating

Your healthcare provider may give you other instructions after the procedure, based on your situation. Talk with your healthcare provider about appropriate types of birth control for you.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much will you have to pay for the test or procedure