Endometrial ablation

Surgery Overview

Endometrial ablation is a procedure that uses a lighted viewing instrument (hysteroscope) and other instruments to destroy (ablate) the uterine lining, or endometrium. Endometrial ablation can be done by:

• Laser beam (laser thermal ablation).
• Heat (thermal ablation), using:
  • Radiofrequency.
  • A balloon filled with saline solution that has been heated to 85°C (185°F) (thermal balloon ablation).
• Electricity, using a resectoscope with a loop or rolling ball electrode.
• Freezing.

The endometrium heals by scarring, which usually reduces or prevents uterine bleeding.

What To Expect After Surgery

Endometrial ablation is usually done in an outpatient facility or hospital. The procedure may be done using a local or spinal anesthesia, although general anesthesia is sometimes used.

Recovery requires from a few days to 2 weeks.

Why It Is Done

Endometrial ablation is used to control heavy, prolonged menstrual bleeding when:

• Bleeding has not responded to other treatments.
• Child-bearing is completed.
• You prefer not to have a hysterectomy to control bleeding.
• Other medical problems prevent a hysterectomy.

How Well It Works

Approximately 90% of women will have reduced menstrual flow following endometrial ablation, and up to half will stop having periods.

Younger women are less likely than older women to respond to endometrial ablation. After an endometrial ablation, younger women are more likely to continue to have periods and need a repeat procedure.

Young women may be treated with either gonadotropin-releasing hormone analogues (GnRH-As) 1 to 3 months before the procedure or other hormones, such as danazol (Cyclomen). This will decrease their production of estrogen and help thin the lining of the uterus (endometrium).

Risks

Complications of endometrial ablation are uncommon but can be quite severe. They can include:

• Accidental puncture (perforation) of the uterus.
• Burns (thermal injury) to the uterus or the surface of the bowel.
• Buildup of fluid in the lungs (pulmonary edema).
• Sudden blockage of arterial blood flow within the lung (pulmonary embolism).
• Tearing of the opening of the uterus (cervical laceration).

What To Think About

Endometrial ablation is not recommended if you have a high risk for endometrial cancer. Regrowth of the endometrium may occur.

Do not consider this procedure if you plan to become pregnant in the future.

Although this surgery usually causes sterility by destroying the lining of the uterus, pregnancy may still be possible if a small part of the endometrium is left in place. Birth control of some form is required if you have not completed menopause and do not wish to become pregnant.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Author:	Merrill Hayden Carrie Henley	Last Updated: May 18, 2006
Medical Review:	Adam Husney, MD - Family Medicine Kathleen Romito, MD - Family Medicine Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
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