Who gets endometrial ablation?

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. Doctors consider menstrual flow to be too heavy if your tampon or sanitary pad is routinely soaked through within two hours.

They may also recommend this procedure if you experience:

  • heavy menstrual bleeding that lasts for eight days or longer
  • bleeding between periods
  • anemia as a result of your period

Endometrial ablation is a permanent procedure. Your uterine lining won’t grow back afterward. This procedure is helpful for many women, but isn’t recommended for everyone. Talk to your doctor about whether this is the best option for you.

How to prepare

Prior to scheduling, you’ll discuss your medication history and any allergies you have with your doctor.

If you and your doctor 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:

You may need to have your uterine lining thinned beforehand in order to make the procedure more effective. This may 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 eight hours before the procedure.

Additional presurgery tests, such as an electrocardiogram, may also be done.

Understand your reproductive options ahead of time

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 want to have children now or later on, you should choose to wait to have this procedure. You should discuss your reproductive options with an infertility specialist before having the procedure.

Your doctor can test your egg quality and quantity through an anti-mullerian 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 doctor about your feelings may be beneficial. They can recommend a counselor or therapist to help you process and provide you with support.

How the procedure is done

In an endometrial ablation, your doctor first inserts a slender instrument through your cervix and into your uterus. This widens your cervix and allows your doctor to perform the procedure.

This can be done in one of several ways. Your doctor’s training and preferences will direct which of the following they will use:

Freezing (cryoablation): A thin probe is used to apply extreme cold to your uterine tissue. Your doctor 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 one to two minutes.

Microwave: An inserted probe uses microwave energy to destroy your uterine lining. This procedure takes three to five minutes to complete.

Electrosurgery: This procedure requires general anesthesia. It uses a telescopic device called a resectoscope and a heated instrument to see and remove uterine tissue.

What to expect after the procedure

The type of procedure you have will determine, in part, your post-procedure care and length of recuperation. If you need general anesthesia, your doctor 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 doctor about over-the-counter medication to take for 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
  • nausea

You should seek emergency medical attention if you experience:

  • foul-smelling discharge
  • fever
  • chills
  • trouble urinating
  • heavy bleeding
  • extreme abdominal cramping

Risks and complications

Women are advised to continue using birth control after having an endometrial ablation. If pregnancy does occur, it’s 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 doctor may recommend sterilization as an additional procedure.

Apart from the very real risk to your fertility, complications from this procedure are rare.

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

Outlook

Recuperation may last anywhere from a few days to a few weeks. During this time, make sure to treat yourself with care. Talk to your doctor 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, you should continue to use birth control to avoid pregnancy and its potential complications. While it’s unlikely that you’ll be able to ever have a baby, a pregnancy can still happen.

As well, you’ll still want to use protection to prevent getting sexually transmitted diseases.