What is endometrial ablation?
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 which are not getting 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?
- Post menopause
- Abnormalities in 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)
- 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?
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 –
A device is inserted into the uterus which destroys the uterine lining using microwave energy.
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.
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, it’s likely that 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, your 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.
What are the risks associated with endometrial ablation?
- Failure of the procedure to control bleeding
- Infection or bleeding
- Rarely, excess fluid build-up in the lungs or brain
- Rarely, injury to the uterine wall, the bowel or the bladder
Call your doctor if you have any of the following symptoms after the ablation procedure –
- Persistent or increasing abdominal pain
- Fever over 101 °C (38 °C) and/or chills
- Shortness of breath
- Heavy vaginal bleeding