Endometrial ablation: What you need to know
A doctor will typically prescribe medication or an intrauterine device (IUD) to help relieve heavy or problematic periods. If these treatments do not work, endometrial ablation is another option.
This article explores the endometrial ablation procedure and things to consider, including side effects, complications, and recovery time.
What is endometrial ablation?
An endometrial ablasion treats excessive bleeding during or in between periods, by removing part of the lining of the uterus.
Endometrial ablation is the removal of the lining of the uterus with the aim of reducing or stopping menstrual flow.
The proper name for the uterus lining is "endometrium." The word "ablation" means to destroy. These two words give the procedure its name.
A 2015 study found endometrial ablation to be an effective treatment for abnormal uterine bleeding (AUB).
Some women choose to have this procedure if they have already tried medication or an IUD to treat AUB.
AUB is when a woman has:
- very heavy periods (more than tampon's worth of blood every hour)
- periods that last more than a week
- bleeding between periods
- bleeding that causes anemia
- bleeding that causes other health problems
Up to 30 percent of women seek help from a doctor for AUB during their lifetime.
Endometrial ablation may completely stop a woman from having periods, or it may just reduce the amount of bleeding. Doctors will only perform the procedure on women who are not pregnant and do not want to become pregnant.
The procedure is not a treatment for any menstrual or uterine problems that are caused by cancer.
Endometrial ablation is not a form of surgery, as it does not involve surgical incisions.
Before the procedure, doctors may need to take a sample of a woman's uterine lining to test it for cancerous or pre-cancerous cells. Endometrial ablation is not suitable for women with cancer.
A doctor will also carry out a visual examination of the uterus using imaging tests, such as ultrasounds, before the procedure. This is to rule out polyps or benign tumors, which may be causing heavy menstruation.
It is also essential to check that a woman is not pregnant. If she has an IUD device, this must be removed before the procedure.
During the procedure, the doctor will insert a thin tool into the vagina and up to the uterus. The steps that follow depend on what type of ablation is taking place.
Types of endometrial ablation
The type of instrument a doctor uses will depend on which procedure is being carried out. There is a range of different types of endometrial ablation, including:
- Hydrothermal: This involves fluid being pumped into the uterus and heated for 10 minutes, which destroys the uterine lining.
- Balloon therapy: A balloon is inserted into the uterus through a tube and filled with heated fluid. As the balloon expands, it destroys the uterine lining.
- High-energy radio waves: An electrical mesh is inserted into the uterus and expanded. Strong radio waves are then passed through the mesh, which causes it to heat up, destroying the uterine lining.
- Freezing: Also known as cryoablation, a thin probe with a cold tip freezes and destroys the lining of the uterus.
- Microwave: Microwaves are passed through the uterus, which destroys the uterine lining.
- Electrical: An uncommon practice is to destroy the uterus lining by passing an electrical current through it.
Endometrial ablation is often carried out in a doctor's office. Sometimes it may be carried out in the hospital or a surgical center.
Partial endometrial ablation
A 2016 study found that an alternative version of the procedure, called partial endometrial ablation (PEA), was also an effective treatment.
PEA is defined as ablating or resecting only the anterior or posterior endometrial wall, instead of the entire uterine lining.
Women who have a classical C-section scar are not advised to undergo endometrial ablation.
Endometrial ablation is not the right option for all women with problematic menstrual bleeding.
The procedure is not advisable for women who are pregnant or who are considering getting pregnant in the future. Endometrial ablation can make getting pregnant much more difficult.
Endometrial ablation is also not advisable for women who have:
- already gone through menopause
- an infection of the vagina or cervix
- cancer of the uterus or cervix
- a classical C-section scar
- an IUD
- a disorder of the uterus
- pelvic inflammatory disease (PID)
- a weak uterine wall
Endometrial ablation does not have a long recovery time. Here is a short timeline outlining what most women experience after the procedure:
- Within 24 hours: Some nausea and the urge to pee.
- For a few days: Cramping or bleeding.
- A week later: Being back to a regular routine.
- For up to 3 weeks: Watery or bloody discharge.
Possible side effects include:
- foul-smelling discharge
- intense cramping or stomach pain
- heavy bleeding
- continual bleeding more than 2 days after the procedure
- trouble passing urine
If a woman experiences any of these symptoms after having endometrial ablation, she should seek medical attention to reduce the risk of infection and other complications.
An endometrial ablation is a procedure that rarely causes any serious side effects or complications.
Endometrial ablation is not a high-risk procedure, but there is a small chance of:
- a hole being made in the uterus
- nearby organs being affected
- fluid used in the procedure getting to the lungs
These complications are rare. It is a good idea to discuss any concerns about risks with a doctor to get reassurance.
Endometrial ablation works well to stop or reduce menstrual bleeding for women who experience heavy or long periods or bleeding in between periods. It is not an option for all women.
Endometrial ablation is usually only carried out as a last resort — if other methods, such as medication or an IUD, have not worked.
The procedure is not suitable for all women, including post-menopausal women. It is a good idea for a woman to talk to her doctor to check whether she is suitable to undergo the procedure.
The results from the procedure are not always permanent.
If a woman continues to experience heavy or long periods after having endometrial ablation, she should speak to her doctor. The doctor will be able to recommend an alternative treatment.