The Endometrial Ablation Procedure is a treatment the doctors use when a woman abnormally bleeds between her menstrual periods.
Endometrial ablation consists of the removal of the endometrium (the lining of the womb).
The procedure is used to control heavy menstrual bleeding in cases when a patient does not desire a hysterectomy. After endometrial ablation, periods usually are much lighter or may cease altogether.
Sometimes, particularly in younger women, heavy periods gradually resume. A second endometrial ablation, or a hysterectomy, may be needed some years later.
Endometrial ablation is surgery or a procedure that is done to remove the lining of the womb to minimize heavy or prolonged menstrual flow. The membrane lining the uterus is called the endometrium.
More often, experts use a tool called a hysteroscope. It is a thin tube with light. It sends pictures of the inside of the uterus to a video monitor.
Most often, doctors usually carry on with the procedure under general anesthesia, but sometimes performed in the office under light sedation.
The health care provider places the endoscope through the vagina and cervix and into the uterus.
Gas or fluid can be placed inside the uterus to dilate it. This helps the medical expert to see the area better. They can see images of the uterus on a video screen.
Small tools can be used through the endoscope to remove abnormal growths or tissue for examination.
Ablation uses heat, cold or electricity to destroy the lining of the uterus. The procedure takes approximately 45 minutes.
Pregnancy is relatively unlikely after endometrial ablation, but if it does occur serious complications can result, so the use of contraception is recommended following the treatment.
People should not regard Endometrial ablation as a mere form of birth control.
Why people choose this procedure.
This procedure can treat very heavy or irregular periods. Your doctor will probably have tried other treatments first, such as hormone medications or IUDs.
Medical experts will not use Endometrial ablation if you want to become pregnant in the future.
Although this procedure does not stop you from getting pregnant, it could reduce your chances of getting pregnant. Reliable contraceptives are essential for all women who choose this treatment.
If a woman becomes pregnant after an ablation procedure, pregnancy will often result in miscarriage or will be high risk due to scar tissue in the uterus.
Methods of Endometrial Ablation
Many experts are using several techniques for endometrial ablation.
They can all usually be carried out as day surgery (i.e., normally no overnight stay is required). Some can use a local or general anesthetic. All of these methods mentioned are sufficient.
The manufacturers of the various devices all provide data showing that their method is superior, but usually these involve small-scale studies.
In other cases, large-scale, independent comparison trials would need to be run to determine which method is the best.
Transcervical Resection of the Endometrium (TCRE) is also known as hysteroscopic resection. The doctor inserts an instrument called a resectoscope via the vagina and cervix.
The resectoscope allows the surgeon to see inside the womb. The tool includes a cauterization loop (heated loop), which is used to destroy the endometrial tissues.
Transcervical resection is a well-established method that usually has a satisfactory outcome. Hot Saline Solution can be introduced into the uterus and used to destroy the endometrial tissue. Sometimes a particular balloon is used.
The Thermachoice III balloon is an example of this method. The medical expert places the uterine balloon in the womb; then it is inflated with saline solution. The solution is gradually heated until it is hot enough to destroy the endometrial tissue.
This method has a high satisfaction rating from patients.
Metal Mesh Systems, such as the Novasure system, involves placing a metal mesh against the endometrium. Radiofrequency energy is used to heat the mesh, destroying the endometrial tissue.
Microwave Endometrial Ablation (MEA) is a technique in which a microwave probe is used to destroy the endometrial tissue. Scientific studies have shown that MEA gives comparable, or better, results than the traditional transcervical resection technique.
Endometrial Ablation Recovery
Cramping, nausea, and vaginal discharge (which can contain blood) may all occur after the operation. The recovery time can be anything from a few days to a fortnight. Painkillers, such as ibuprofen or acetaminophen (paracetamol) can be taken to reduce any pain.
Possible Side-Effects and Complications
- Side effects seem to be rare, regardless of the method employed.
- Burns to the muscular lining of the womb, or even to the bowel, can occur.
- Perforation of the womb (uterus) is an infrequent, but potentially harmful complication.
- Post-ablation tubal sterilization syndrome is a complication in which swelling of the fallopian tubes occurs. The main symptoms are pelvic pain and unusual vaginal bleeding. The syndrome occurs in women who have previously had a tubal sterilization procedure, then gone on to have endometrial ablation.
- Cardiovascular complications sometimes occur, but are very rare.
Risks of a hysterectomy include:
- Hole (perforation) on wall of uterus
- Scarring of the lining of the uterus
- Damage to the cervix
The dangers related to any pelvic surgery include:
- Damage to nearby organs or tissues
- Blood clots that can go into the lungs and become deadly (rarely)
Risks of anesthesia include:
- Nausea and vomiting
- A headache
- Respiratory problems
- Lung infection
The dangers that any surgery involves:
The lining of the uterus heals when it heals. Women will often have less menstrual bleeding after this procedure. Up to 30 to 50% of women will stop having periods at all. This condition is quite common in older women.
Before the procedure.
Doctors will perform a biopsy of the endometrium or lining of the uterus in the weeks before the procedure.
They can treat younger women with a hormone that blocks the manufacture of estrogen in the body for 1 to 3 months before the treatment.
Your healthcare provider may prescribe medication to dilate your cervix. This facilitates insertion of the endoscope. You should take this medicine 8 to 12 hours before the procedure.
After the procedure.
You could go home the same day. Rarely, you will need to stay overnight.
You may have menstrual-like cramps and mild vaginal bleeding for 1 to 2 days. Ask your provider if you can take over-the-counter pain relievers for colic.
However, you will probably have an aqueous discharge for several weeks.
You can return to daily activities within 1 to 2 days. Do not have sex until your provider says you can.
All biopsy results are usually available within 1 to 2 weeks. Your doctor will give you the results of your procedure.