What is endometrial ablation?

Endometrial ablation is the surgical destruction of the lining tissues of the uterus, known as the endometrium. Endometrial ablation is one type of treatment for abnormal uterine bleeding.

Why is endometrial ablation done?

Endometrial ablation is a treatment for abnormal bleeding of the uterus that is due to a benign (non-cancerous) condition. Endometrial ablation is not sufficient for treatment of bleeding due to cancer of the uterus, since cancer cells may have grown into the deeper tissues of the uterus and would not be removed by the procedure.

Endometrial ablation is only performed on a nonpregnant woman who does not plan to become pregnant in the future. It should not be performed if the woman has an active infection of the genital tract. Endometrial ablation is not a first-line therapy for heavy bleeding and should only be considered when medical and hormonal therapies have not been sufficient to control the bleeding.

How is endometrial ablation performed?

Prior to the procedure, a woman needs to have an endometrial sampling (biopsy) performed to exclude the presence of cancer. Imaging studies and/or direct visualization with a hysteroscope (a lighted viewing instrument that is inserted to visualize the inside of the uterus) are necessary to exclude the presence of uterine polyps or benign tumors (fibroids) beneath the lining tissues of the uterus. Polyps and fibroids are possible causes of heavy bleeding that can be simply removed without the need for ablation of the entire endometrium. Obviously, the possibility of pregnancy must be excluded, and intrauterine contraceptive devices (IUDs) must be removed prior to considering endometrial ablation.

Hormonal therapy may be given in the weeks prior to the procedure (particularly in younger women), in order to shrink the endometrium to an extent whereby ablation therapy has the greatest likelihood of success; because the thinner the endometrium, the greater the chances for successful ablation.

To begin the procedure, the cervical opening is dilated to allow passage of the instruments into the uterine cavity. Different procedures have been used and are all similarly effective for destroying the uterine lining tissue. These include laser beam, electricity, freezing, heating, or microwave energy.

The choice of procedure depends upon a number of factors, including

• the preference and experience of the surgeon,
  
  
• the presence of fibroids, the size and shape of the uterus,
  
  
• whether or not pretreatment medication is given, and
  
  
• the type of anesthesia desired by the patient.

The type of anesthesia required depends upon the method used, and some endometrial ablation procedures can be performed with minimal anesthesia during an office visit. Others may be performed in an outpatient surgery department.

What are the risks and complications of endometrial ablation?

Complications of the procedure are not common but may include:

• accidental perforation of the uterus,
  
  
• tears or damage to the cervical opening (the opening to the uterus), and
  
  
• infection, bleeding, and burn injuries to the uterus or intestines.

In rare cases, fluid used to expand the uterus during the procedure can be absorbed into the bloodstream, leading to fluid in the lungs (pulmonary edema).

Some women may experience regrowth of the endometrium and need further surgery (see below).

Minor side effects of the procedure can occur for a few days, include cramping (like menstrual cramps), nausea, and frequent urination for 24 hours. A watery discharge mixed with blood may be present for a few weeks after the procedure and can be heavy for the first few days.

What is the outlook after endometrial ablation?

The majority of women who undergo endometrial ablation report a successful reduction in abnormal bleeding. Up to half of women will stop having periods following the procedure. However, studies have shown that 6% to 25% of women report that their heavy bleeding pattern was unchanged one year following the procedure, and some women will require further surgery (re-ablation or hysterectomy) to control the bleeding. About 10% of women who have endometrial ablation will eventually have a hysterectomy.

Although the procedure removes the uterine lining and typically results in infertility, it should not be considered as a birth control measure, because pregnancy can still occur of a small portion of the endometrium was left in place or has regrown. In this case there may be severe problems with the pregnancy, and the procedure should never be performed if the woman may desire pregnancy in the future.

Endometrial Ablation At A Glance

• Endometrial ablation is the surgical destruction of the lining tissues of the uterus.
  
  
• Endometrial ablation is one type of treatment for abnormal uterine bleeding that is due to a benign (non-cancerous) condition.
  
  
• Endometrial ablation must not be performed if pregnancy is desired in the future.
  
  
• Laser beam, electricity, freezing, heating, and microwave energy are all successfully used methods for endometrial ablation. The choice of procedure depends upon a number of factors.
  
  
• Some women may experience regrowth of the endometrium and require further surgery.

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