Endometrial or uterine ablation surgically destroys the uterine lining, the endometrium. Surgeons typically do the procedure to reduce menstrual flow in women experiencing excess blood loss. There are multiple methods of uterine ablation and many contraindications and risks.
To perform a uterine ablation, the doctor inserts a slender tool through the vagina and cervix, into the uterus. The specific device depends on the method, but the procedure does not require a surgical incision. The minimally invasive nature of the procedure means it can be performed in a doctor’s office, but most uterine ablations take place in an operating room.
Cryoablation and Heat
One approach to performing uterine ablation is extreme temperatures. Cryoablation uses a probe to generate temperatures of −100°C to −120°C to freeze and destroy the endometrium. The doctor guides and monitors the operation using a live ultrasound. Heat is another option; the physician will either circulate heated saline through the uterus or insert a heated balloon. Each of these methods takes about 10 minutes.
Electrosurgery, Microwave, Radiofrequency
Electrosurgery is another ablation method. The doctor uses a heated wire loop to destroy the endometrium. This procedure requires general anesthesia and can be quite painful. Microwaves can also heat and destroy the endometrial tissue. This approach takes as little as five minutes. Another option is radiofrequency, which vaporizes the tissue in just a few minutes.
Why It’s Done
The most common reason for uterine ablation is long or heavy periods. It can also address bleeding between periods. Some women experience bleeding that is so heavy, it interferes with their quality of life and can cause anemia. Many factors, including hormonal problems, polyps, fibroids, and uterine or endometrial cancer, can cause excess bleeding.
Because the goal of uterine ablation is to stop heavy menstrual bleeding, it affects reproduction. A fertilized egg normally implants into the endometrial lining, but uterine ablation removes this lining. Women can still get pregnant, as their reproductive organs remain intact, but pregnancy after the procedure is high-risk, and miscarriage is likely, so doctors recommend using effective birth control or undergoing sterilization.
There are several risks associated with uterine ablation, including bleeding, infection, fluid overload, and tearing of the bowel or uterine wall. Less severe complications can include stomach or pelvic pain, nausea, and vomiting. Women who are allergic to any medications, latex, or iodine must inform their doctor before the procedure. Some underlying conditions can also increase the chance of complications.
If a woman is pregnant or thinks she could be, she cannot have uterine ablation. Other factors that can make a person ineligible for the procedure include an active cervical or vaginal infection, a recent pregnancy, weakness of the uterine wall, an abnormal uterine shape, an IUD, and a history of c-section, fibroid surgery, or pelvic inflammatory disease. Women with uterine, endometrial, or cervical cancer also cannot receive uterine ablation.
Before the Procedure
Preparation for uterine ablation includes a biopsy of the endometrium, primarily to rule out cancer as the cause of the bleeding. The doctor will often prescribe hormone blockers to women of child-bearing age to prevent their bodies from making estrogen for a few months before the procedure. The patient must also stop taking any blood thinners or NSAIDs before the procedure to lessen bleeding risks. The day before the procedure, the doctor may prescribe medicine to open the cervix, so it is easier to insert the scope.
After the Procedure
In most cases, women go home the same day as the procedure, though an overnight hospital stay is required in some instances. Menstrual-like cramps and light bleeding are normal for a day or two after uterine ablation, and clear discharge can continue for several weeks. Often, NSAIDs are sufficient for alleviating pain. Most women can return to normal activity one or two days later but must abstain from sex until cleared by the doctor. Any biopsy results are usually available within two weeks.
Uterine ablation is not always immediately effective. It may take a few months to determine the final result, but blood loss during menstruation usually begins to slow. Some women stop getting their periods altogether. One of the most significant complications of the procedure is pregnancy. Uterine ablation does not reduce fertility, but it does prevent a fertilized egg from implanting properly, which can be dangerous.