Endometrial ablation facts

• Endometrial ablation is the surgical destruction of the lining tissues of the uterus.
• Endometrial ablation is one type of treatment for abnormal uterine bleeding that is due to a benign (non-cancerous) condition.
• Endometrial ablation must not be performed if pregnancy is desired in the future.
• Laser beam, electricity, freezing, and heating are all successfully used methods for endometrial ablation. The choice of procedure depends upon a number of factors.
• Some women may experience regrowth of the endometrium and require further surgery.

What is endometrial ablation?

Endometrial ablation is the surgical destruction of the lining tissues of the uterus, known as the endometrium. Endometrial ablation is one type of treatment for abnormal uterine bleeding.

Why is endometrial ablation done?

Endometrial ablation is a treatment for abnormal bleeding of the uterus that is due to a benign (non-cancerous) condition. It is not a sufficient treatment when bleeding is caused by cancer of the uterus, since cancer cells may have grown into the deeper tissues of the uterus and can't often be removed by the procedure.

Endometrial ablation is only performed on a nonpregnant woman who does not plan to become pregnant in the future. It should not be performed if the woman has an active infection of the genital tract. This treatment is not a first-line therapy for heavy bleeding and should only be considered only when medical and hormonal therapies have not been sufficient to control the bleeding.

How is endometrial ablation performed?

Prior to the procedure, a woman needs to have an endometrial sampling (biopsy) performed to exclude the presence of cancer. Imaging studies and/or direct visualization with a hysteroscope (a lighted viewing instrument that is inserted to visualize the inside of the uterus) are necessary to exclude the presence of uterine polyps or benign tumors (fibroids) beneath the lining tissues of the uterus. Polyps and fibroids are possible causes of heavy bleeding that can be simply removed without ablation of the entire endometrium. Obviously, the possibility of pregnancy must be excluded, and intrauterine contraceptive devices (IUDs) must be removed prior to endometrial ablation.

Hormonal therapy may be given in the weeks prior to the procedure (particularly in younger women), in order to shrink the endometrium to an extent where ablation therapy has the greatest likelihood for success. The belief is the thinner the endometrium, the greater the chances for successful ablation.

To begin the procedure, the cervical opening is dilated to allow passage of the instruments into the uterine cavity. Different procedures have been used and are all similarly effective for destroying the uterine lining tissue. These include laser beam, electricity, freezing, and heating.

The choice of procedure depends upon a number of factors, including

• the surgeon's preference and experience,
• the presence of fibroids, the size and shape of the uterus,
• whether or not pretreatment medication is given, and
• type of anesthesia desired by the patient.

The type of anesthesia required depends upon the method used, and some endometrial ablation procedures can be performed with minimal anesthesia during an office visit. Others may be performed in an outpatient surgery center.

What are the risks and complications of endometrial ablation?

Complications of the procedure are not common but may include:

• accidental perforation of the uterus,
• tears or damage to the cervical opening (the opening to the uterus), and
• infection, bleeding, and burn injuries to the uterus or intestines.

In very rare cases, fluid used to expand the uterus during the procedure can be absorbed into the bloodstream, leading to fluid in the lungs (pulmonary edema).

Some women may experience regrowth of the endometrium and need further surgery (see below).

Minor side effects from the procedure can occur for a few days, include cramping (like menstrual cramps), nausea, and frequent urination that may last for 24 hours. A watery discharge mixed with blood may be present for a few weeks after the procedure and can be heavy for the first few days.

Complications of endometrial ablation are rare and can include:

• Pain, bleeding or infection
• Heat or cold damage to nearby organs
• A puncture injury of the uterine wall from surgical instruments

Future fertility

Pregnancy can occur after endometrial ablation. However, these pregnancies might be higher risk to mother and baby. The pregnancy might end in miscarriage because the lining of the uterus has been damaged, or the pregnancy might occur in the fallopian tubes or cervix instead of the uterus (ectopic pregnancy).

Some types of sterilization procedures can be done at the time of endometrial ablation. If you are having endometrial ablation, long-lasting contraception or sterilization is recommended to prevent pregnancy.

Unfortunately, there is no cure or medication for endometrial ablation. The treatment is meant to fix problems with the uterus that cause heavy bleeding, and it usually does so for a period of time. After that time period has passed, though, the symptoms may return, and you may have to get another endometrial ablation.

• First and foremost, talk to your doctor about what kind of pain management options they can offer.
• If you have any other health issues or medical conditions, make sure you let them know about those too so they can assess whether there are any specific medications or treatments that will help manage your symptoms in conjunction with the procedure itself.
• Other medications include, Mifepristone, also known as RU-486, is a medication that blocks progesterone production.
• It has been shown to reduce bleeding and improve symptoms of uterine fibroids, but it's not typically used to treat endometriosis.
• However, researchers are looking into its potential as a treatment for endometrial ablation.
• Danazol is a synthetic male hormone that helps prevent ovulation in women who have undergone menopause. It can also be used to treat endometriosis and uterine fibroids.
• Danazol is taken orally in pill form one week before and during the week of surgery. After the patient goes off of the drug, they should continue their normal activities without restrictions because there are no side effects associated with this medication.
• If you're just looking for something to take the edge off during recovery, anti-inflammatory medications like ibuprofen or aspirin may be helpful—but be sure not to take these without consulting with a medical professional first.

Symptoms
Abdominal pain, cramping, and bloating,Bleeding between periods,Excessive bleeding during your period,Spotting between periods
Conditions
Chronic pelvic pain syndrome,Dysmenorrhea,Fibroids,Menorrhagia,Polycystic ovary syndrome
Drugs
Anti-inflammatory medications like ibuprofen and aspirin,Antibiotics like tetracycline, doxycycline, minocycline and others,Antivirals like acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex),Antifungals like ketoconazole and griseofulvin,Antiplatelet drugs such as clopidogrel (Plavix)