Endometrial ablation

By Dr. Amber Hayden, DO

Endometrial ablation is a medical procedure that is used to remove or destroy the endometrial lining of a uterus to reduce or stop abnormal uterine bleeding. Women with excessive or irregular menstrual flow often ask me about endometrial ablation as a possible solution.

Woman with her doctor discussing endometrial ablation

If you’re considering endometrial ablation, I recommend making an appointment with your doctor right away to discuss your goals and expectations for this procedure. With endometrial ablation, there’s a lot to think about.

Here are some key factors to consider as you make your decision:

What is “abnormal” uterine bleeding?

The term abnormal uterine bleeding is used when there is a significant change in your menstrual flow such as bleeding after menopause, and prolonged or excessive bleeding either at regular intervals (menorrhagia), or irregular intervals (menometrorrhagia). Abnormal uterine bleeding can occur at any age but often it affects women in their late 30s to early 40s.

How do you know if you need an endometrial ablation?

When addressing abnormal uterine bleeding, the first step is to find the source and make sure it’s not being caused by infection, fibroids, pregnancy, or malignancy (endometrial carcinoma). To know for sure, your doctor may suggest lab tests, ultrasound and an endometrial biopsy.

Once secondary causes have been ruled out, you’ll have several options. One of the first possibilities typically includes hormonal therapy such as oral birth control pills or the levonorgestrel intrauterine device of IUD (Mirena). If neither of these treatments is successful, the next step is to consider an endometrial ablation or hysterectomy. Compared to a hysterectomy, endometrial ablation is a minimally-invasive alternative when other options don’t work.

What happens during an endometrial ablation?

Endometrial ablation removes a thin layer of tissue (endometrium) from the uterus using a non-surgical procedure performed by a gynecologist. No cutting is involved during an endometrial ablation and it can be performed at a doctor’s office, surgical outpatient facility, or sometimes in the hospital if anesthesia is chosen.

During an endometrial ablation, the doctor is able to view the uterus by introducing a thin camera in a lighted tube, called a hysterscope. Next, a second device is inserted to ablate — or destroy — the endometrial lining of the uterus via freezing or heating, or with lasers.

Almost all women who undergo this procedure are able to go home the same day. Many experience irregular bleeding due to the procedure, and it takes around 8-12 weeks for the desired effects to be fully seen. After an endometrial ablation, about 85% of women have either no periods or decreased bleeding. About 10-15% will require additional treatment, either with a repeat procedure or hysterectomy. Women younger than 45 have a higher rate of recurrence.

Who needs an endometrial ablation? Is it risky?

Women who choose endometrial ablation often:

Suffer from abnormal uterine bleeding and do not respond to other treatments.
Do not want to get pregnant in the future.
Do not want to have or are ineligible for a hysterectomy

There are severe risks with endometrial ablation though they are not common. These include accidental perforation (puncture) of the uterus, thermal injury to the uterus or the surface of the bowel, infection, bleeding or overloading of fluid into the bloodstream, and miscarriage. Having endometrial ablation can also mask one of the most common symptoms of endometrial carcinoma: post-menopausal bleeding.

Most women will be unable to get pregnant after this procedure. And pregnancy following endometrial ablation is risky for both the woman and the fetus. Therefore, it’s essential to use an effective method of birth control or even choose to have a tubal ligation (permanent sterilization) prior to the procedure.

Again, if you have medical problems that leave you considering endometrial ablation, I strongly suggest an immediate discussion with your doctor to choose the right course of treatment for you. I usually advise my patients to explore all the available treatment options for abnormal uterine bleeding before pursuing any sort of major procedure.

Information is power. When you fully understand the pros and cons of endometrial ablation, you’ll be able to make the best decision for your individual situation.