What is Endometrial Ablation? Indications, Procedure, Risks and More

December 23, 2022 · 5 minutes

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For many women with unexplained heavy period bleeding, endometrial ablation could be a solution. Read to learn about its indications, contraindications, risks, and more.

What is endometrial ablation?

Endometrial ablation is a surgical procedure in which the inner lining of the uterus (endometrium) is destroyed using heat, cold, or any other source of energy. This is done to minimise your bleeding during menstruation.

Why is endometrial ablation done?

A woman’s uterus is where a foetus (developing baby) grows. The endometrium is the soft tissue that lines the uterus. It fills with blood during each menstrual cycle.

Each month, if you don’t become pregnant, the blood-rich tissue of the endometrium is shed, leading to periods (menstruation). The amount of blood lost during this time varies from woman to woman, but bleeding that soaks a pad or tampon every hour, bleeding that lasts more than a week, or bleeding between periods can be a sign of a problem. Although tests can often reveal the cause of heavy bleeding, sometimes it remains unknown.

In such cases, the endometrium is destroyed (ablated) using heat, cold, or other forms of energy. This results in reduced or normal bleeding during periods. Some women may also experience no bleeding after the procedure.

Who undergoes endometrial ablation?

Endometrial ablation is recommended if:

You have heavy periods that are not being relieved by medicines
You are certain that you do not want to get pregnant and are willing to use some form of birth control
You do not have any identifiable causes for bleeding, such as cancer or thyroid hormone imbalances

What are the contraindications of endometrial ablation?

Pregnancy
Post menopause
Abnormalities in the uterus
Uterine cancer or increased risk of uterine cancer
Pelvic infections

How can I prepare for endometrial ablation?

You will be advised to take the following tests before the procedure:

Urine pregnancy test to determine if you are pregnant (endometrial ablation is contraindicated during pregnancy)
A biopsy of the uterus to rule out cancer
Ultrasound or MRI to have an in-depth picture of the uterus

You should not be under any blood thinners during the procedure.
You may be prescribed medicines that thin your uterus.
Before the procedure, you would have to fast for at least 8 hours (no food or water).

What happens during an endometrial ablation?

You will be given anaesthesia to minimise discomfort during the procedure.
Your uterus is injected with fluids to reduce the bleeding and give your doctor a clear view of your endometrium. Your doctor then inserts a small telescope-like instrument connected to a video monitor through your cervix. This gives them greater visibility and allows them to control the ablation process. A device that releases energy is connected to the end of the scope and the uterine lining is destroyed. There are a wide range of devices for endometrial ablation. Your doctor picks the appropriate instrument based on your anatomy and the severity of your condition.

What are the types of endometrial ablation?

Different energy sources are used for endometrial ablation. However, all of them function to destroy the endometrial lining. The various types are:

Microwave
A device is inserted into the uterus that destroys the uterine lining using microwave energy.
Cryoablation
A chilled probe is inserted into the uterus, which destroys the uterine lining as the extreme cold at the probe’s tip freezes the uterine sections. Your doctor can monitor the development using an ultrasound. It takes roughly six minutes to complete one freezing cycle. The size and shape of the uterus will determine how many cycles are required.
Electrocautery
The uterus is visualised using a thin scope and a tool, such as wire loop, a probe with a roller ball tip, or an electrode tip is, introduced. The uterine lining is removed or destroyed by this device using an electric current. General anaesthesia is required for electrocautery ablation. This is less frequently used compared to other techniques.
Radiofrequency ablation
A flexible, triangular device is inserted, and the uterus is opened using a specialised tool. The uterine lining is destroyed by radiofrequency energy released by the ablation device in 1 to 2 minutes. After that, the device is taken out of the uterus.
Hydrothermal ablation
The uterus is filled with a pre-heated fluid for around 10 minutes, and the inner lining is destroyed by heat. This method’s benefit is that it can be used on a patient whose uterus has an uneven shape due to abnormal tissue growth (conditions like uterine lesions or uterine fibroids can lead to the uterus being misshapen).
Heated balloon
A tiny tube (catheter) is inserted into the uterus by your healthcare professional and this catheter’s tip is capped with a balloon. The balloon is heated, and filled with fluid. The lining is destroyed by the hot fluid released from the balloon.

What happens after endometrial ablation?

After surgery, ask someone to pick you up from the hospital since you may experience some abdominal cramping or pain. Your doctor prescribes medicines to help minimise the discomfort. You may also have a bloody or watery discharge or bleeding like a period for days or weeks. Use sanitary pads, not tampons. Refrain from sexual intercourse and active sports for 2 weeks after surgery. In a couple of days, you can return to work. Your doctor will review you in person after about 6 weeks to make sure you’re healing well.

After ablation, bleeding should decrease. Even if it doesn’t stop totally, the flow is likely to be much lighter. Remember, you still need regular pap tests and pelvic exams to rule out other uterine problems. The final results of the procedure may be evident after a couple of months. Your Bleeding during periods will get lighter and may sometimes completely stop. Despite endometrial ablation, you are still at risk of getting pregnant, which could be dangerous and result in miscarriage. Hence, always use contraception or get yourself or your partner sterilised.