Endometrial Ablation

What is endometrial ablation?

Endometrial ablation is an outpatient surgical procedure for the treatment of abnormal uterine bleeding in pre-menopausal women. This may be an alternative to hysterectomy in women who are having heavy or prolonged menstrual periods. Before a woman has this procedure she should have a thorough evaluation of her bleeding. This may include blood tests, ultrasounds and a biopsy of the endometrium (uterine lining). Hormonal therapy is usually tried before surgery is performed. Women who fail hormonal therapy or who cannot take hormones may be candidates for endometrial ablation. This procedure is not recommended for post-menopausal women or women who may have uterine cancer.

How is the procedure performed?

The procedure is generally performed in a hospital operating room with the patient asleep. However, in selected patients it can be performed in a physician’s office with intravenous or oral sedation. The goal of the surgery is to destroy the lining of the uterus, which is the source of the abnormal bleeding. There are several devices that can accomplish this by utilizing electrical energy, heated water, microwaves or cryotherapy (freezing). Each device has its advantages and disadvantages, but there does not appear to be a significant difference in the results among the various techniques. The endometrial ablation procedure is performed by inserting an instrument into the uterine cavity and activating the energy source. The procedure takes about 10 minutes to complete. The patient is discharged home shortly afterwards.

What to expect after the procedure

Uterine cramping and mild vaginal bleeding for several days after the procedure should be expected. Patients are given oral pain medication to take after the surgery to help with the pain. Patients can usually return to work 1-2 days after this surgery. This procedure does not affect your ovaries or ovulation. Therefore if you were ovulating prior to this surgery, you will still ovulate afterwards. Endometrial ablation is not a contraceptive procedure and you should not rely on this for contraception. Pregnancies have been reported in women who have had an endometrial ablation.

What should happen to your menstrual periods after this surgery

The ideal outcome of this procedure is complete elimination of menstrual periods. This happens in about 20-25% of patients so you should not necessarily expect that you will stop having periods after this surgery. Approximately 60% of patients will still have menstrual periods, but have a decrease in their flow. Approximately 15-20% of patients will have no improvement in their periods after this surgery.