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:

For ablations using a hysteroscope

You will be asked to remove clothing. You will be given a gown to wear.
An IV (intravenous) line may be started in your arm or hand.
You will lie on an operating table, with your feet and legs supported as for a pelvic exam.
Your healthcare provider may put a catheter into your bladder to drain urine.
Your healthcare provider will put a tool (speculum) into your vagina. They will use it to spread open your vagina and see the cervix.
Your provider will clean your cervix with an antiseptic solution.
Your provider may use a type of forceps to hold the cervix steady for the procedure.
Your provider will open the cervix by putting in thin rods. Each rod will have a wider diameter than the previous one. This process will gradually make the cervix opening larger so your provider can put in the hysteroscope.
Your healthcare provider will put the hysteroscope through the cervical opening and into the uterus.
Your provider may use a liquid or gas to fill the uterus. This will help them see it better.
Your provider will put the ablation tool through the hysteroscope. They will move a roller ball or wire loop with electrical current across the uterus lining. This will destroy the lining.
For hydrothermal ablation, your provider will put a heated liquid into the uterus through a catheter. The liquid is pumped around your uterus to destroy the lining.
After the procedure is done, your provider will pump any fluid out from your uterus and remove the instrument.

For other types of ablations

You will be asked to remove clothing. You will be given a gown to wear.
An intravenous (IV) line may be started in your arm or hand.
You will lie on a procedure table, with your feet and legs supported as for a pelvic exam.
Your healthcare provider will put a tool (speculum) into your vagina. They will use it to widen your vagina and see the cervix.
Your provider will clean your cervix with an antiseptic solution.
The healthcare provider will numb the area using a small needle to inject medicines.
Your provider will insert a thin, rod-like tool (uterine sound) through the cervical opening. This is to find out how long your uterus and cervical canal are. The tool may cause some cramping. The tool will then be removed.
With balloon ablation, your provider will put a small balloon through the cervical opening and into your uterus. They will put hot liquid into the balloon to destroy the uterus lining. A computer will control the pressure, temperature, and time of the treatment. This may cause some mild to strong cramping.
With radiofrequency ablation, your provider will put a special mesh through the cervical opening. They will expand it to fill the uterus. Radio wave energy will be passed into the mesh. This will destroy the uterus lining. Suction helps remove liquids, steam, and other gases that will be made during ablation. This may cause some mild to strong cramping.
For cryoablation, your provider will put a special probe through the cervical opening and into the uterus. They will place an ultrasound transducer on your abdomen. This will guide the cryoablation probe to the right areas in the uterus for freezing. This may cause some mild to strong cramping.
When the procedure is done, your provider will remove the tools.

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