Endometrial ablation is a procedure designed to destroy the uterine lining (endometrium).
Your doctor may recommend this procedure if your menstrual periods are extremely heavy and can’t be controlled with medication.
Healthcare providers consider menstrual flow to be too heavy if your tampon or sanitary pad is routinely soaked through within 2 hours, according to the Mayo Clinic.
They may also recommend this procedure if you experience:
- heavy menstrual bleeding that lasts for 8 days or longer, per the Mayo Clinic
- bleeding between periods
- anemia as a result of your period
While in most cases the endometrial lining is destroyed, regrowth of the lining can occur in normal and abnormal ways. In younger women, tissue regrowth may occur months or years later.
This procedure is helpful for many women, but it isn’t recommended for everyone. Talk to your healthcare provider about whether this is the best option for you.
Prior to scheduling, your healthcare provider will request your medication history, including any allergies you have.
If you and your healthcare provider decide to move forward with the procedure, they’ll discuss all aspects of the procedure with you ahead of time. This includes what you should and shouldn’t do in the days and weeks leading up to it.
Standard pre-procedure protocols include:
- taking a pregnancy test
- having your IUD removed, if you have one
- being tested for endometrial cancer
Your uterine lining may need to be thinned beforehand to make the procedure more effective. This can be done with medication, or with a dilation and curettage (D and C) procedure.
Not all endometrial ablation procedures require anesthesia. If general anesthesia is needed, you’ll be instructed to stop eating and drinking 8 hours before the procedure, according to Johns Hopkins Medicine.
Additional presurgery tests, such as an electrocardiogram, may also be done.
Endometrial ablation isn’t meant to be a sterilization procedure, but it usually is. Although your reproductive organs remain intact, conception and successful pregnancy afterward is unlikely.
If you’re planning to have children, you should choose to wait to have this procedure. You should discuss your reproductive options with an infertility specialist before having the procedure.
Your healthcare provider can test your egg quality and quantity through an anti-Müllerian hormone (AMH) or follicle-stimulating hormone (FSH) blood test. If your eggs are of good quality, you can opt to freeze your eggs or fertilized embryos prior to the procedure.
Although it isn’t guaranteed that frozen eggs or embryos will result in pregnancy, having them may provide this option later on. A surrogate might carry the pregnancy for you.
If freezing your eggs or embryos isn’t an option, you may decide to use an egg donor and a surrogate to conceive. If you can choose to delay the procedure until you have children, you might want to do so. Adoption is also a consideration.
Weighing these options, as well as the need for the procedure, may feel overwhelming. Talking to your healthcare provider about your feelings may be beneficial. They can recommend a counselor or therapist to help you process and provide you with support.
In an endometrial ablation, your healthcare provider first inserts a slender instrument through your cervix and into your uterus. This widens your cervix and allows them to perform the procedure.
The procedure can be done in one of several ways. Your healthcare provider’s training and preferences will direct which of the following procedures they’ll use:
Freezing (cryoablation): A thin probe is used to apply extreme cold to your uterine tissue. Your healthcare provider places an ultrasound monitor on your abdomen to help them guide the probe. The size and shape of your uterus determines how long this procedure lasts.
Heated balloon: A balloon is inserted into your uterus, inflated, and filled with hot fluid. The heat destroys the uterine lining. This procedure typically lasts from 2 to 12 minutes.
Heated free-flowing fluid: Heated saline liquid is allowed to flow freely throughout your uterus for around 10 minutes, destroying the uterine tissue. This procedure is used in women with irregularly shaped uterine cavities.
Radiofrequency: A flexible device with a mesh tip is placed into your uterus. It emits radiofrequency energy to eliminate uterine tissue in 1 to 2 minutes.
Microwave: An inserted probe and microwave energy is used to destroy your uterine lining. This procedure takes 3 to 5 minutes to complete.
Electrosurgery: This procedure requires general anesthesia. A telescopic device called a resectoscope and a heated instrument is used to see and remove uterine tissue.
The type of procedure you have will determine, in part, the length of recovery. If you need general anesthesia, your healthcare provider will have you remain in the hospital for several hours after surgery.
No matter what type of procedure you have, you’ll need someone to take you home afterward.
You should also bring a sanitary napkin with you to wear after the procedure is completed. Talk to your healthcare provider about over-the-counter medication recommendations for treating cramps or nausea, and which ones to avoid.
After the procedure, you may experience:
- increased urination for about a day
- menstrual-type cramping for several days
- watery, bloody vaginal discharge for several weeks
You should seek emergency medical attention if you experience:
- foul-smelling discharge
- trouble urinating
- heavy bleeding
- extreme abdominal cramping
Women are advised to continue using birth control after having an endometrial ablation. If pregnancy does occur, it’s more likely to result in miscarriage.
Normally, the endometrial lining thickens in response to pregnancy. Without a thick endometrial lining, an embryo can’t implant and grow successfully. For this reason, your healthcare provider may recommend sterilization as an additional procedure.
Apart from the very real risk to your fertility, complications from this procedure are rare, according to the Mayo Clinic.
These rare risks can include:
- puncturing of your uterine wall or bowels
- postsurgical infection or bleeding
- damage to your vagina, vulva, or bowels from the hot or cold applications used during the procedure
- absorption of the fluid used during the procedure into your bloodstream
late-onset endometrial ablation failure, a condition where the endometrium grows back abnormally after the procedure.
Recovery may last anywhere from a few days to a few weeks. During this time, make sure to treat yourself with care. Talk to your healthcare provider about when you can expect to resume daily activities, as well as more strenuous exercise and sexual intercourse.
After the procedure, your periods should lighten or stop completely within a few months.
If you didn’t undergo sterilization and you’ve chosen to practice sex with birth control, you should continue to use your preferred method. Birth control can help prevent pregnancy and its potential complications.
While it’s unlikely that you’ll be able to conceive and carry a child full term, a pregnancy can still happen.
It’s also still important to practice sex with a condom or other barrier method to prevent the transmission of sexually transmitted infections (STIs).