Endometrial Ablation

What is endometrial ablation?

Endometrial ablation is a procedure for destroying or removing the inner lining of the uterus. The uterus is the muscular organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus. The lining of the uterus is called the endometrium.

When is it used?

This procedure may be done when you have bleeding from the uterus that is very heavy or has lasted a long time and other treatments have not helped. Destroying or removing the lining of the uterus may reduce or stop the bleeding. It does not change your hormone levels.

Examples of possible alternatives to this procedure are:

• hormone therapy to stop menstrual bleeding
• the progesterone intrauterine device (IUD) called the Mirena
• dilation and curettage (D&C), which is a procedure for opening the cervix and then scraping or suctioning tissue from the uterus
• removal of the uterus (hysterectomy)
• choosing not to have treatment

You should not have this procedure if:

• You are or have just recently been pregnant.
• You want to be able to get pregnant in the future.
• You have a uterine or pelvic infection.
• You have cancer of the uterus or cervix.
• You have had recent surgery on the uterus.
• You have a disorder of the endometrium, such as an endometrial lining that is too thin or abnormal precancerous cells.

Ask your provider about your choices for treatment and which might be best for you.

How do I prepare for endometrial ablation?

Before you have the procedure, your healthcare provider may prescribe progesterone hormones or other medicine to stop your body from making estrogen for a while. This will shrink the lining of the uterus.

Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find other people to help you with your day-to-day tasks.

Smokers have more complications with surgery and heal more slowly after surgery. Smokers are more likely to have breathing problems during surgery. If you smoke, follow your healthcare provider's instructions about not smoking before and after the procedure. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before the procedure, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before the procedure.

Follow any other instructions your provider gives you. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight or the morning before the procedure. Do not even drink coffee, tea, or water.

Your provider may put a laminaria into the cervix the day before the procedure. Laminaria is a small rod made of seaweed that absorbs moisture. It will help soften and dilate the cervix. It can make the procedure easier and safer to perform.

What happens during the procedure?

Some endometrial ablation procedures can be done in your provider’s office. Others are done at a hospital or surgery center.

You will be given a local, regional, or general anesthetic. A local or regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the procedure. You may be given a sedative with the local or regional anesthetic to relax you. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

Your healthcare provider may use a tool to stretch open (dilate) your cervix. The cervix is the opening to the uterus. Your provider will guide a thin tube called a catheter or another tool into your vagina, through the cervix, and into your uterus.

The lining of the uterus may be destroyed in different ways, such as:

• a probe that freezes the lining
• a probe that sends radiofrequency energy into the lining and then uses suction to remove it.
• heated fluid put into the uterus with a scope
• a balloon put into the uterus with a scope and then filled with heated fluid
• a probe that uses microwave energy to destroy the lining
• a scope and electrical tool, like an electrical wire loop

It usually takes only a few minutes to do the ablation.

What happens after the procedure?

Usually you can go home the same day as the procedure

After the procedure you may:

• feel sleepy or groggy from the anesthetic
• have some cramps
• have trouble urinating for the first few hours after the procedure
• have a watery or bloody discharge for 3 or 4 weeks

Many women don’t have any menstrual bleeding after ablation. Some do keep having periods but with just normal or light bleeding. You will probably not be able to get pregnant after this procedure. However, there is a chance you could get pregnant. If you do get pregnant, the risk of miscarriage and other problems is much higher. If you have concerns about this, talk to your healthcare provider. Your provider may advise you to use birth control.

Ask your healthcare provider how to care for yourself after the procedure. Ask when you should come back for a checkup.

What are the benefits of this procedure?

Bleeding from the uterus should stop or be much less after the procedure.

Endometrial ablation is a short procedure. Recovery from it is quick and easy. Ablation can help you avoid the discomfort, hospitalization, expense, and longer recovery of a hysterectomy.

What are the risks associated with this procedure?

This is usually a very safe procedure with few complications. Possible complications may include:

• A local or regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. In most cases, local or regional anesthesia is considered safer than general anesthesia. There are some risks when you have general anesthesia. Discuss these risks with your provider.
• You may have infection or bleeding.
• Rarely, the uterus could be punctured and need surgery to repair it.
• Rarely, the bowel or bladder may be injured.
• The procedure may not control the abnormal bleeding. You may need more treatment or surgery.
• If you get pregnant, you are more likely to have a miscarriage or other problems.

Ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You start to bleed a lot (more than a menstrual period).
• You have a fever over 100.5°F (38°C).
• You have a lot of pain in your lower belly.
• You have a vaginal discharge with a bad odor.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.