An endometrial ablation is a medical procedure used to destroy the lining, or endometrium, of the uterus. This procedure is used as a treatment for heavy menstrual bleeding, which may be caused by a hormonal imbalance, fibroid tumors, or a number of other benign issues. It is a non-surgical alternative that is often suggested in lieu of a hysterectomy when bleeding cannot be controlled with medication or other non-invasive treatments.
Prior to an endometrial ablation, a physician usually exams the uterus with an instrument called a hysteroscope. This instrument is an extremely thin telescope that can be inserted into the uterus via the cervix. It is so narrow that the cervix experiences almost no dilation, and it has a light used to illuminate the inside of the uterus. Some doctors also use ultrasonography to view the uterus, and a biopsy of the uterine wall will likely be taken to ensure there are no signs of uterine cancer.
When the physician has ensured there are no problems that would be exacerbated by the procedure or impede the process, one of several methods will be utilized to perform the endometrial ablation. These include: freezing, heated fluid, heated balloon, radio frequency, and microwave energy. For most of the procedures, a probe or hysteroscope is inserted through the cervix, then the selected method is applied and the endometrium is destroyed.
Physicians who choose to employ heat may do so by using one of two options. The first is to use the hysteroscope to flood the uterus with heated fluid. The second method involves a balloon. The balloon is inserted with a hysteroscope, then heated fluid is inserted into the balloon, which expands until it is touching the uterine lining on all sides. All of the procedures are short and take place either in a doctor's office or at an outpatient surgery center.
Various pain medications are given, depending on the method of ablation, but most patients recover in a couple of hours. Patients may experience cramping, nausea, frequent urination, and a watery discharge. In most cases, patients can return to work and engage in normal activities within a day or two.
Endometrial ablation often stops menstrual bleeding completely. Other women may continue to have menstrual bleeding, but at a greatly reduced amount. If endometrial ablation is not successful in controlling excessive bleeding, surgery is the next alternative. Endometrial ablation is not suitable for women who still intend to bear children, have had a recent pregnancy, are post-menopausal, or have uterine cancer, endometrial hyperplasia, or an infection of the uterus.