Endometrial ablation involves the surgical removal of the lining of the uterus. It may involve using heat, cold temperatures, microwave energy, or other methods. Ablation procedures are used to treat menorrhagia, recurrent heavy periods that cannot be controlled with medication. Endometrial ablation likely will make menstrual flow lighter or, in some cases, it stops menstrual flow completely.
Talk to your doctor about your plans for having a baby. This procedure should not be done if you have plans to become pregnant in the future.
Is there anyone who should not have endometrial ablation?
Endometrial ablation should not be done in women who are past menopause and is not recommended for those with the following medical conditions:1
- Disorders of the uterus or endometrium
- Endometrial hyperplasia
- Cancer of the uterus
- Recent pregnancy
- Current or recent infection of the uterus
Can I still get pregnant after an ablation?
Pregnancy is not likely after an ablation procedure, but has been known to happen. Women who want to become pregnant again should not have an endometrial ablation. Those who do have the procedure should still use birth control because, while the chances of becoming pregnant are low, there is an increased risk of miscarriage or other complications if it does happen. Some women choose to undergo a sterilization procedure after ablation.
Since a woman still has her reproductive organs following an endometrial ablation, she should still have routine pelvic examinations and pap testing to screen for cervical cancer.
What should I expect before, during, and after the procedure?
Before The Procedure
Prior to the procedure, your doctor will likely:
- Do an endometrial biopsy, ultrasound, or hysteroscopy of your uterus to check for abnormalities and to understand the shape and size of your uterus.
- Ask about:
- Your medical history
- Medications or herbs and supplements you take
- Any allergies you have
- Whether you are pregnant or trying to get pregnant
- If you have an intrauterine device (IUD)
In addition, prior to the procedure, you may need to:
- Ask your doctor about your options because there are many types of endometrial ablation.
- Talk to your doctor about your medications. You may be asked to stop taking some medications up to 1 week before the procedure.
- Take medication to thin the lining of the uterus.
- Arrange for someone to drive you home from the care center. You also may need help at home.
- Avoid smoking.
The day before the procedure:
- Have a light dinner.
- Do not eat or drink anything after midnight.
During the Procedure
There are many different ways for the doctor to do an endometrial ablation. A simple ablation procedure is short and can sometimes be done in a physician’s office or care center. Other procedures take longer and need to be done in a hospital.
There are 3 options for anesthesia during ablation, and your doctor will help you decide which one is right for you:
- General anesthesia —blocks pain and keeps you asleep through the procedure.
- Regional anesthesia —blocks pain in the area, but you stay awake through the procedure; given as an injection
- Local anesthesia—just the area that is being operated on is numbed; given as an injection
During the procedure, the doctor does not make any incisions to access the uterus. Often, ultrasound is used to help guide the doctor. A tiny probe is inserted through the vagina and into the uterine cavity through the cervix. Depending on the method, the tip of the probe will expand to deliver:
- Radiofrequency—heat and energy
- Cryoablation—freezing temperature
- Heated fluid
- Heated balloon
- Microwave energy
- Electrosurgery—uses electrical current and a heated rollerball or spiked ball)
You will not feel pain. All of these methods are used to destroy the cells lining the uterine cavity. Suction may be used to remove the tissue that has been destroyed.
The length of the procedure depends on the method used, but typically takes between 15 and 45 minutes. Endometrial ablation usually is done on an outpatient basis. You may need to stay there for 1-2 hours following the procedure. Some methods may require an overnight hospital stay.
After the Procedure
Following the ablation, you may feel:
- Cramping and discomfort, similar to menstrual cramps, for 1–2 days.
- Thin, watery discharge mixed with blood, which may be heavy for 2 to 3 days after the procedure and can last for a few weeks.
- Frequent urination for a day or so.
After the procedure, your doctor will give you pain medication and ensure that you feel well enough to go home if the procedure used does not require a hospital stay.
When you return home, do the following to help ensure a smooth recovery:
- Talk to your doctor about how your fertility has been affected by the procedure and discuss family planning options.
- Have routine Pap tests and pelvic exams.
If you experience any of the following, call your doctor right away:
- Heavy vaginal bleeding
- Severe abdominal cramping and pelvic pain
- Severe pain during sex
- Severe low back pain
- Pain during bowel movements or urination
- Signs of infection, including fever and chills
- Nausea and vomiting
- Cough, chest pain, or shortness of breath
- Pain or tenderness in the calf or leg
- Menstruation does not get lighter after 2-3 periods
In case of an emergency, call 911.
Are there any complications from having endometrial ablation?
Complications from endometrial ablation are rare, but all surgical procedures carry some risk. If you are planning to have endometrial ablation, your doctor will review a list of possible complications, which may include:
- Complications related to anesthesia
- Uterine perforation or organ injury
- Edema (swelling) due to fluid leakage and absorption
- Thermal (heat) injury to the vagina, vulva, or bowel
If you have a history of painful periods or tubal sterilization, you also may be at risk for developing new or worsening pain after this procedure. If there is time before your procedure, talk to your doctor about ways to manage factors that can increase your risk of complications such as:
- Chronic disease, such as diabetes or obesity
The following also may increase your risk of complications:
Pregnancy or possible pregnancy—procedure should not be done if there is a chance that you are pregnant
- History of pelvic inflammatory disease (PID)—may trigger a recurrence of PID
- Inflammation of the cervix
1American College of Obstetricians and Gynecologists (ACOG): www.acog.org
Dr. Mona Sadek, Ob/Gyn with LewisGale Physicians, is available to discuss your options if you are interested in an ablation. To schedule an appointment, call the office at (540) 725-7326 or click below to book an appointment online.