Endometrial Ablation

• Endometrial ablation is the process of destroying the tissue layer lining the internal cavity of the uterus (i.e. endometrium).
• Several different forms of energy can be used for ablation. These include electricity, heat, cold, and microwaves.
• Endometrial ablation is performed (usually by an experienced OB/GYN physician) as a treatment for abnormal or heavy uterine bleeding when medical and/or hormonal treatments have been ineffective or are not medically appropriate.
• Endometrial ablation is not an appropriate treatment for uterine cancer, because it only destroys the most superficial tissue layer of the uterine wall, and most cancers burrow more deeply into the uterine wall.

Endometrial ablation is not an appropriate treatment for bleeding in every woman. It cannot be performed when a woman is pregnant or when a woman desires to become pregnant at any time in the future. Endometrial ablation should not be performed when there is infection in the genital tract. Prior to the procedure, the woman must undergo a thorough physical examination including a sampling (biopsy) of the endometrium to confirm that cancer is not present.

Imaging studies and/or visual examination of the uterine cavity using a hysteroscope (a lighted viewing instrument that is inserted to visualize the inside of the uterus) are typically also carried out to exclude the presence of abnormalities, such as uterine polyps or benign (fibroid) tumors beneath the endometrium, that could be responsible for the heavy bleeding. These can often be simply removed without the need for destruction of the entire endometrium.

Because a thinner endometrium is easier to destroy, some women may need to take hormonal medications during the weeks prior to the procedure for optimal results. These medications serve to thin the endometrial lining and increase the likelihood of a successful ablation procedure.

If a woman has an intrauterine contraceptive device (IUD) in place, it must be removed prior to the procedure being performed.

The type of anesthesia for the procedure varies, depending upon the technique used and the type of patient under treatment. Some types of endometrial ablation procedures can be carried out with minimal anesthesia during an office visit (for example, cryogenic probe), while others may be performed in an outpatient surgery department. Many physicians are concerned that the office procedures require more anesthesia for pain control than is safe to do in the office, while others feel that they can adequately control the pain without taking the patient to the operating room. Patients and doctors should discuss these options before an ablation procedure is performed.

It is necessary to dilate the opening of the cervix (the opening to the uterine cavity) to allow passage of the ablation instruments into the uterine cavity. A number of ablation methods are available and are effective for destruction of the endometrial tissue. These include, electricity, freezing, heating, or microwave energy. The choice of procedure depends upon a number of factors, including the preference and experience of the OB/GYN surgeon, the presence of any anatomical abnormalities or fibroids, the size and shape of the uterus, and the type of anesthesia desired by the patient.

Minor side effects can occur following the procedure. These may include:

• cramping (similar menstrual cramps) for a few days
• nausea
• frequent urination (for 24 hours)
• vaginal discharge: (A watery discharge mixed with blood, which may be heavy for the first few days following the procedure, with resolution over a few weeks.)

Serious complications of endometrial ablation are not common but they may include:

• infection,
• bleeding,
• perforation of the uterus,
• tears or damage to the cervical opening (the opening to the uterus), and
• burns of the uterus or intestines with certain ablation techniques (for example, laser or microwave ablation procedures).

Very rarely, the fluid used to expand the uterus during the procedure can be absorbed into the bloodstream, leading to fluid in the lungs (pulmonary edema).

Some women may experience regrowth of the endometrium over time and may require further surgery.

It is important to adhere to your OB/GYN surgeon's recommendations regarding follow-up examinations and visits. Some women do experience a regrowth of endometrium that can lead to recurrent bleeding. Inform your physician if you are experiencing any adverse effects or recurrence of symptoms.

Most women report that an ablation procedure (regardless of the type of procedure chosen) leads to a diminution of the abnormal bleeding, but some women (6%-25%) have reported heavy bleeding that was unchanged at one year following the procedure. These women may require further surgery (re-ablation or hysterectomy) to control the bleeding. About half of the women who had endometrial ablation will not have periods at all following the procedure.

Endometrial ablation should not be considered a birth control measure, even though the destruction of the uterine lining typically results in infertility. Pregnancy can still occur (and may be associated with serious complications, such as miscarriage) when a small portion of the endometrium was left in place or has regrown.