Endometrial Ablation

Procedure overview
What is an endometrial ablation?

Endometrial ablation is a procedure to permanently remove a thin tissue layer of the lining of the uterus to stop or reduce excessive or abnormal bleeding in women for whom childbearing is complete. The lining of the uterus is called the endometrium. In some cases, endometrial ablation may be an alternative to hysterectomy.

There are several techniques used to perform endometrial ablation including the following:

Electrical or electrocautery—electric current travels through a wire loop or rollerball that is applied to the endometrial lining to cauterize the tissue
Hydrothermal—heated fluid is pumped into the uterus and destroys the endometrial lining with high temperature
Balloon therapy—a balloon at the end of a catheter is inserted into the uterus and filled with fluid, which is then heated to the point that the endometrial tissues are eroded away
Radiofrequency ablation—a triangular mesh electrode is expanded to fill the uterine cavity. The electrode delivers electrical current and destroys the endometrial lining.
Cryoablation (freezing)-—a probe uses extremely low temperatures to freeze and destroy the endometrial tissues
Microwave ablation - microwave energy is delivered through a slender probe that has been inserted into the uterus and destroys the endometrial lining.

Some endometrial ablation procedures are performed using a hysteroscope, a lighted viewing device inserted through the vagina for a visual examination of the canal of the cervix and the interior of the uterus. Ablation instruments can be inserted through the opening and a camera or video camera can be used to record findings through the hysteroscope.

A resectoscope may be used instead of the hysteroscope. This device is similar to the hysteroscope but has a built-in wire that uses electrical current for resecting (removing) endometrial tissue.

Other ablation techniques use ultrasound to guide the instrument to the areas for treatment. Ultrasound is a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs.

Other related procedures used for treating the endometrium include dilation and curettage (D & C), hysteroscopy, endometrial biopsy, and hysterectomy. Please see these procedures for additional information.

What are female pelvic organs?

The organs and structures of the female pelvis are:

Endometrium—the lining of the uterus
Uterus—also called the womb, the uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.
Ovaries—two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored and where the female sex hormones estrogen and progesterone are produced
Cervix—the lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body
Vagina—the passageway through which fluid passes out of the body during menstrual periods. Also called the "birth canal," the vagina connects the cervix and the vulva (the external genitalia)
Vulva—the external portion of the female genital organs

The menstrual cycle

With each menstrual cycle, the endometrium prepares itself to nourish a fetus as increased levels of estrogen and progesterone help to thicken its walls. If fertilization does not occur, the endometrium, coupled with blood and mucus from the vagina and cervix (the lower, narrow part of the uterus located between the bladder and the rectum) make up the menstrual flow (also called menses) that leaves the body through the vagina. After menopause, menstruation stops and a woman should not have any bleeding.

Reasons for the procedure

Menorrhagia is a condition in which a woman has extremely heavy or prolonged menstrual periods. Bleeding between periods is called abnormal uterine bleeding. In some cases, bleeding may be so severe and relentless that daily activities become interrupted and anemia develops.

In general, bleeding is considered excessive when a woman soaks through enough sanitary products (sanitary napkins or tampons) to require changing every hour. Bleeding is considered prolonged when a woman experiences a menstrual period that lasts longer than seven days.

Menorrhagia and abnormal uterine bleeding may be due to a hormone imbalance or disorder (particularly estrogen and progesterone), especially in women approaching menopause or after menopause. Other causes of abnormal bleeding include the presence of abnormal tissues such as fibroid tumors (benign tumors that develop in the uterus, also called myomas), polyps, or cancer of the endometrium or uterus.

Depending on the cause of the bleeding, endometrial ablation may be recommended to destroy the lining of the uterus. Because the endometrial lining is destroyed, it can no longer function normally, and bleeding is stopped or controlled. In most cases, a woman cannot become pregnant after endometrial ablation because the lining that nourishes a fetus has been removed. However, after ablation, a woman still has her reproductive organs.

There may be other reasons for your physician to recommend endometrial ablation.

Risks of the procedure

As with any surgical procedure, complications may occur. Some possible complications of endometrial ablation may include, but are not limited to, the following:

Bleeding
Infection
Perforation of the uterine wall or bowel
Overloading of fluid into the bloodstream

Patients who are allergic to or sensitive to medications, iodine, or latex should notify their physician.

If you are pregnant or suspect that you may be pregnant, you should notify your physician. Endometrial ablation during pregnancy may lead to miscarriage. In most cases, a woman will not be able to become pregnant after an endometrial ablation. If a woman does become pregnant after ablation, the limited tissue left lining the uterus may not be adequate for a fetus to implant and be nourished.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

An endometrial ablation may be contraindicated for patients with the following conditions. These conditions include, but are not limited to, the following:

Vaginal or cervical infections
Pelvic inflammatory disease
Cervical, endometrial, or uterine cancer
Weakness of the uterine muscle wall
Intrauterine device (IUD)
Previous dilation and curettage
Classic or vertical c-section incision

Certain factors or conditions may interfere with certain types of endometrial ablation. These factors include, but are not limited to, the following:

Narrowing of the inside of the cervix
Short length of uterine cavity

Before the procedure

Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
If your procedure requires general, spinal, or epidural anesthesia, you will be asked to fast for eight hours before the procedure, generally after midnight.
If you are pregnant or suspect that you are pregnant, you should notify your physician.
Notify your physician if you are sensitive to or are allergic to any medications, iodine, latex, tape, and anesthetic agents (local and general).
Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
Your physician may prescribe medication(s) to help thin the endometrial tissues in preparation for the ablation procedure. You may need to take the medication(s) for several weeks before the procedure.
You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
You may want to bring a sanitary pad to wear home after the procedure.
Based upon your medical condition, your physician may request other specific preparation.

During the procedure

An endometrial ablation may be performed in a physician’s office, on an outpatient basis, or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

The type of anesthesia will depend upon the specific procedure being performed. Ablations using a hysteroscope or resectoscope may be performed while you are asleep under general anesthesia, or while you are awake under spinal or epidural anesthesia. If spinal or epidural anesthesia is used, you will have no feeling from your waist down. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery. Local anesthesia may be used for other types of ablations.

Generally, an endometrial ablation follows this process:

For ablations using a hysteroscope or resectoscope:

You will be asked to undress completely and put on a hospital gown.
An intravenous (IV) line may be started in your arm or hand.
You will be positioned on an operating or examination table, with your feet and legs supported as for a pelvic examination.
A urinary catheter may be inserted.
Your physician will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
Your cervix may be cleansed with an antiseptic solution.
A type of forceps, called a tenaculum, may be used to hold the cervix steady for the procedure.
The cervix will be dilated by inserting a series of thin rods. Each rod will be larger in diameter than the previous one. This process will gradually enlarge the opening of the cervix so that the hysteroscope or resectoscope can be inserted.
The hysteroscope or resectoscope will be inserted through the cervical opening into the uterus.
A liquid solution or carbon dioxide gas may be used to fill the uterus for better viewing.
The ablation instrument will be inserted through the hollow opening of the hysteroscope. A rollerball or wire loop with electrical current will be passed across the endometrial tissues, destroying the tissues.
For hydrothermal ablation, a heated liquid is placed into the uterus through a catheter and circulated with a computer-controlled pump until the endometrial tissues are destroyed by the high temperatures.
After the procedure has been completed, any fluid will be pumped out from your uterus and the instruments will be removed.

For other types of ablation techniques:

You will be asked to undress completely and put on a hospital gown.
An intravenous (IV) line may be started in your arm or hand.
You will be positioned on an examination table, with your feet and legs supported as for a pelvic examination.
Your physician will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
Your cervix may be cleansed with an antiseptic solution.
The physician will numb the area using a small needle to inject medication.
A thin, rod-like instrument, called a uterine sound, may be inserted through the cervical opening to determine the length of the uterus and cervical canal. This may cause some cramping. The sound will then be removed.
With balloon ablation, a silicone balloon will be inserted through the cervical opening into the uterine cavity and will be connected by a catheter to a computer console. Hot liquid will be circulated inside the balloon to destroy the endometrial tissues. The pressure, temperature, and time of the treatment will be controlled by the computer. This may cause some mild to strong cramping.
With radiofrequency ablation, a triangular mesh electrode will be inserted through the cervical opening and expanded to fill the uterine cavity. Radio-frequency energy will be passed into the mesh to destroy the tissues it contacts. Suction helps remove liquids, steam, and other gases that will be produced during ablation. This may cause some mild to strong cramping.
For cryoablation, a special probe that produces very cold temperatures will be inserted through the cervical opening into the uterus. An ultrasound transducer will be placed on your abdomen to guide the cryoablation probe to the appropriate areas in the uterus for freezing. This may cause some mild to strong cramping.
The instruments will be removed.

After the procedure

The recovery process will vary depending upon the type of ablation performed and the type of anesthesia that was administered.

If you received spinal, epidural or general anesthesia, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. If this procedure was performed on an outpatient basis, you should plan to have another person drive you home.

If you did not receive anesthesia, you will need to rest for about two hours before going home.

You may want to wear a sanitary pad for bleeding. It is normal to have vaginal bleeding for a few days after the procedure. You may also have a watery-bloody discharge for several weeks.

You may experience strong cramping, nausea, vomiting, and/or the need to urinate frequently for the first few days after the procedure. Cramping may continue for a longer time.

You may be instructed not to douche, use tampons, or have intercourse for two to three days after an endometrial ablation, or for the period of time recommended by your physician.

You may also have other restrictions on your activity, including no strenuous activity or heavy lifting.

You may resume your normal diet unless your physician advises you differently.

Take a pain reliever for cramping or soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Your physician will advise you on when to return for further treatment or care.

Notify your physician if you have any of the following:

Foul-smelling drainage from your vagina
Fever and/or chills
Severe abdominal pain
Excessive bleeding, or heavy bleeding longer than two days after the procedure
Difficulty urinating

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online Resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your physician. Please consult your physician with any questions or concerns you may have regarding your condition.

This page contains links to other Web sites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these Web sites, nor do these sites endorse the information contained here.

American Cancer Society

American Congress of Obstetricians and Gynecologists

American Society for Reproductive Medicine

National Cancer Institute (NCI)

National Institutes of Health (NIH)

National Library of Medicine

National Women's Health Information Center