Endometrial ablation is a procedure that removes the lining tissue of a woman's uterus; this tissue, called the endometrium, is what creates a period when it is shed each month. Some women have problems with heavy period bleeding or with bleeding that lasts longer than normal. An endometrial ablation procedure is one choice to help decrease or stop abnormal bleeding.
Reasons to Consider Endometrial Ablation
Endometrial ablation can be used to improve abnormal bleeding that is caused by hormone changes. It can also sometimes be helpful when a woman has abnormal bleeding caused by fibroids, which are common benign growths in the uterus. A woman who wants to get pregnant in the future should not have this procedure, but an ablation is not a reliable form of birth control. This method cannot be used to treat cancer.
Procedure
The procedure may be performed in a doctor's office or in an operating room, with either local or general anesthesia. An overnight stay is usually not necessary. All the techniques used to perform endometrial ablation involve inserting a device through the vagina and cervix into the inner cavity of the uterus to remove or destroy the uterine lining. Because no incision is made in the skin, the recovery time is much shorter than recovery from a hysterectomy. No organs are removed during the procedure.
Methods
The endometrial ablation procedure is performed using a variety of techniques, but they all produce similar results.
Some methods use heat to destroy the uterine lining cells. This can be done using a silicone balloon, which is inserted into the uterus while empty, and then filled with hot liquid. The liquid causes the balloon to expand to fit the uterine cavity, and the 189-degree liquid destroys the lining. A method called hydrothermal ablation inserts the liquid directly into the uterus.
The radiofrequency method uses a collapsible mesh-netlike structure that expands inside the uterus to deliver radiowave energy to the endometrium. Other methods use small specialized probes that are placed inside the uterus to destroy the lining by freezing, or cryotherapy, by microwave energy or by electricity.
Recovery
Most women will be able to go home on the day of the surgery. Women usually experience some cramping, similar to menstrual cramps, for a day or two after surgery. Some women will experience nausea from the anesthesia medications. There is also typically a watery, blood-tinged discharge that can last for several weeks. Your doctor will provide instructions about when it is safe to return to work, to having sex and to exercise.
Risks
It is unusual to have serious problems as a result of an ablation procedure. Complications that have occurred include injuries to the vagina, uterus or intestines; infection; absorption of excessive fluid into the bloodstream; and problems related to the anesthesia. Some problems may require surgery to correct, but this is uncommon.
Benefits
The effects of an endometrial ablation vary, depending on each individual situation. According to Dr. Ayman Shaamash, professor of OBGYN at Assiut University, more than 80 percent of women who have the procedure will experience periods that are normal or lighter than normal; about one-third of women will have no bleeding at all afterward. According to Dr. Mindyn Longinotti, OBGYN physician at Kaiser Permanente, the majority of women will be able to avoid having a hysterectomy. Dr. Rajesh Varma, lecturer in OBGYN at the Birmingham Women's Hospital, found that most women report less PMS and less painful periods than before the procedure. According to a 2009 study by Dr. Hector Chapa, director of Women's Specialty Center in Dallas, most women report that they are happy with the results of the procedure.
References
- "Journal of Reproductive Medicine"; In-office Endometrial Ablation and clinical correlation of reduced menstrual blood loss and effects on dysmenorrhea and premenstrual symptomatology; HO Chapa; April 2009
- "Obstetrics and Gynecology"; Probability of Hysterectomy After Endometrial Ablation; Mindyn K. Longinotti MD; December 2008
- "Journal of Obstetrics and Gynaecology Research"; Prediction of successful menorrhagia treatment after thermal balloon endometrial ablation; AH Shaamash; June 2004
- "Gynecologic and Obstetric Investigation"; Outpatient Thermachoice endometrial balloon ablation: long-term, prognostic and quality-of-life measures; Rajesh Varma; June 2010
- "Nezhat's Operative Gynecologic Laparoscopy and Hysteroscopy"; Camran Nezhat; 2008.
