Definition

Endometrial ablation is a surgery or procedure done to disrupt the lining of the uterus in order to minimize heavy or prolonged menstrual flow. This lining is called the endometrium. The surgery may be done in a hospital, outpatient surgery center, or the health care provider's office.

Alternative Names

Hysteroscopy - endometrial ablation; Laser thermal ablation; Endometrial ablation - radiofrequency; Endometrial ablation - thermal balloon ablation; Rollerball ablation; Hydrothermal ablation; Novasure ablation

Description

Endometrial ablation is a procedure used to treat abnormal bleeding by destroying tissue in the uterine lining. The tissue can be removed using:

• High frequency radio waves
• Laser energy
• Heated fluids
• Balloon therapy
• Freezing
• Electrical current

Some types of procedures are done using a thin, lighted tube called a hysteroscope that sends images of the inside of the womb to a video monitor. Most of the time general anesthesia is used so you will be asleep and pain free.

However, newer techniques can be done without using a hysteroscope. For these, a shot of numbing medicine is injected into the nerves around the cervix to block pain.

Why the Procedure Is Performed

This procedure can treat heavy or irregular periods. Your provider will likely have tried other treatments first, such as hormone medicines or an IUD.

Endometrial ablation will not be used if you may want to become pregnant in the future. Though this procedure does not prevent you from getting pregnant, it may reduce your chances of getting pregnant. Reliable contraception is important in all women who get the procedure.

If a woman gets pregnant after an ablation procedure, the pregnancy will often miscarry or be extremely high risk because of the scar tissue in the uterus.

Risks

Risks of hysteroscopy include:

• Hole (perforation) in the wall of the womb
• Scarring of the lining of the womb
• Infection of the uterus
• Damage to the cervix
• Need for surgery to repair damage
• Severe bleeding
• Damage to the bowels

Risks of ablation procedures vary depending on the method used. Risks may include:

• Absorption of excess fluid
• Allergic reaction
• Pain or cramping following the procedure
• Burns or tissue damage from procedures using heat

Risks of any pelvic surgery include:

• Damage to nearby organs or tissues
• Blood clots, which could travel to the lungs and be deadly (rare)

Risks of anesthesia include:

• Nausea and vomiting
• Dizziness
• Headache
• Breathing problems
• Lung infection

Risks of any surgery include:

• Infection
• Bleeding

Before the Procedure

A biopsy of the endometrium or lining of the uterus will be performed in the weeks prior to the procedure. Younger women may be treated with a hormone that blocks estrogen from being made by the body for 1 to 3 months before the procedure.

Your provider may prescribe medicine to open your cervix. This makes it easier to insert the scope. You need to take this medicine about 8 to 12 hours before your procedure.

Before any surgery:

• Always tell your provider about all the medicines you take. This includes vitamins, herbs, and supplements.
• Tell your provider if you have diabetes, heart disease, kidney disease, or other health problems.
• If you smoke. If so, try to stop. Ask your provider for help. Smoking can slow wound healing.

In the 2 weeks before your procedure:

• You may need to stop taking drugs that make it hard for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), clopidogrel (Plavix), and warfarin (Coumadin). Your provider will tell you what you should or should not take.
• Ask your provider which medicines you can take on the day of your procedure.
• Tell your provider if you have a cold, flu, fever, herpes outbreak, or other sickness.
• You will be told when to arrive at the hospital. Ask if you need to arrange for someone to drive you home.

On the day of the procedure:

• You may be asked not to drink or eat anything 6 to 12 hours before your procedure.
• Take any approved drugs with a small sip of water.

After the Procedure

You may go home the same day. Rarely, you may need to stay overnight.

• You may have menstrual-like cramps and light vaginal bleeding for 1 to 2 days. Ask your provider if you can take over-the-counter pain medicine for the cramping.
• You may have a watery discharge for up to several weeks.
• You can return to normal daily activities within 1 to 2 days. Do not have sex until your provider says it is OK.
• Any biopsy results are usually available within 1 to 2 weeks.

Your provider will tell you the results of your procedure.

Outlook (Prognosis)

The lining of your uterus heals by scarring. Women will most often have less menstrual bleeding after this procedure. Up to 30% to 50% of women will completely stop having periods. This result is more likely in older women. Women who continue to have heavy bleeding may need additional surgery.

References

Baggish MS. Minimally invasive nonhysteroscopic endometrial ablation. In: Baggish MS, Karram MM, eds. Atlas of Pelvic Anatomy and Gynecologic Surgery. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 107.

Kintanar TA. Endometrial ablation. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 133.

Raymond L, Lentz GM. Endoscopy in minimally invasive gynecologic surgery. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 10.