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Heavy menstrual bleeding might seem like just a nuisance, but the truth is it can be a lot more than just a periodic inconvenience. Excessive blood loss, at any point during the menstrual cycle, is a health concern you should always take seriously. Fortunately, many options can help regulate and decrease heavy uterine bleeding, including endometrial ablation.
What is endometrial ablation?
Endometrial ablation is a medical procedure usually performed by a gynecologist. It destroys the endometrium, the innermost layer of the uterus (Minalt, 2021).
Why is an endometrial ablation performed?
When options like birth control fail to stop heavy bleeding, your doctor may recommend a procedure known as endometrial ablation. Endometrial ablation treats abnormal uterine bleeding by destroying the endometrium (Minalt, 2021).
Abnormal uterine bleeding may present as heavy periods, bleeding in between periods, or menstrual bleeding that lasts longer than a week. Abnormal bleeding affects approximately 10% to 30% of people of reproductive age. Losing too much blood can cause anemia, a lack of healthy red blood cells that affects your blood’s ability to transport oxygen, or necessitate a blood transfusion (Mishra, 2018).
About 20% of people who experience heavy menstrual bleeding have a bleeding disorder such as Von Willebrand disease or platelet dysfunction. Excessive bleeding can also be caused by uterine issues such as polyps, adenomyosis, fibroids, endometrial cancer, and endometrial hyperplasia. Or it may be caused by conditions that cause irregular ovulation, such as polycystic ovarian syndrome (PCOS) or certain hormonal or blood-thinning medications (Wouk, 2019).
Your doctor will want to figure out the cause of the abnormal bleeding before doing an endometrial ablation. Other treatment options may be available depending on the cause of your abnormal uterine bleeding.
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How to prepare
Before scheduling an endometrial ablation, your doctor will likely assess the shape and structure of your uterine cavity using a thin, lighted tube called a hysteroscope. This procedure is called a hysteroscopy.
During the hysteroscopy, your healthcare provider will also take an endometrial biopsy to ensure the tissue is normal and not cancerous. While endometrial ablation can treat your heavy bleeding, it will not cure the condition causing the bleeding (Wouk, 2019).
What happens during an endometrial ablation
Your uterus has three layers: the perimetrium, myometrium, and endometrium. The innermost layer, the endometrium, creates the tissue that sheds during menstruation (Gasner, 2021). Endometrial ablation works by destroying the layers of the endometrium that shed and regrow each cycle (Minalt, 2021).
Gynecologists use two main approaches when performing endometrial ablation procedures: resectoscopic and non-resectoscopic (Famuyide, 2018).
Resectoscopic procedures utilize a resectoscope, a tube-like device with a lens that allows physicians to cut away at tissue, and require filling the uterus with fluid so the doctor can see inside of it (Famuyide, 2018). These procedures aren’t used as much today because there are new and better methods that don’t require those techniques.
These newer non-resectoscopic techniques are just as effective as their predecessors. They’re also easier and safer (Minalt, 2018). Current non-resectoscopic options include (Angioni, 2016):
- Electrical current: A tool goes into the uterus and passes an electrical current through a wire loop or rollerball, destroying the endometrial tissue.
- Radiofrequency ablation: Electrical mesh placed inside the uterus expands and uses radio waves to impair the uterine wall.
- Thermal balloon ablation: A thin tube containing a balloon goes inside the uterus. The balloon inflates and fills with fluids that, once heated, damage the endometrium.
- Microwave ablation: Microwave energy goes through a thin probe placed in the uterus. These waves then destroy the uterine lining.
- Hydrothermal ablation: Heated fluids fill the uterus and destroy the endometrium.
- Cryoablation: The uterine lining is frozen using a probe set to a cold temperature.
Recovery after an endometrial ablation
Endometrial ablations are typically outpatient procedures, meaning you get to go home the same day (Minalt, 2018). Your healthcare provider will give you medication to help manage your pain during and after the procedure. The type of medication depends on your provider and health history.
Non-resectoscopic techniques typically use local anesthesia, a medication that numbs the area, or conscious sedation. Resectoscopic methods are more likely to require general anesthesia. After the procedure, you may experience side effects such as cramping, pelvic pain, and vaginal bleeding for a few days. Because the devices pass through the vagina and cervix before entering the uterus, you may experience some post-procedure discomfort in those areas as well (Laberge, 2015).
Risks associated with endometrial ablation
Endometrial ablations are not safe for everyone. You should not undergo the procedure if you have an active pelvic infection, endometrial hyperplasia, endometrial cancer, uterine anomaly, intrauterine device (IUD), or went through menopause (Minalt, 2021).
Medical professionals do not recommend them for people who plan on getting pregnant in the future. Damaging the endometrium can cause infertility and lead to pregnancy complications such as preterm delivery, issues with the placenta, fetal growth restrictions, miscarriage, and stillbirth (Minalt, 2021). Although the procedure can make it difficult to get pregnant, it is not a form of sterilization. You should still use contraception to prevent pregnancy and sexually transmitted infections.
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Though highly effective, the procedure is not without risks. Like any medical procedure, it comes with a slight chance of infection. Other potential complications include cervical, vaginal, or vulvar burns; uterine trauma; and retention of menstrual blood (Famuyide, 2018).
While it prevents hysterectomy in four out of five people who undergo the procedure, some people do not experience enough relief and may ultimately need their uterus removed (Famuyide, 2018).
The good news is most people, between 85% to 98%, are happy with the outcome of their endometrial ablation. And it doesn’t matter which type of procedure you get. Resectoscopic and non-resectoscopic procedures have similar success rates; 82% to 97% of people treated reported decreased bleeding a year following their procedure (Famuyide, 2018).
If you experience heavy menstrual bleeding and think that you would benefit from an endometrial ablation, reach out to your healthcare provider to see what options are available to you.
- Angioni, S., Pontis, A., Nappi, L., Sedda, F., Sorrentino, F., et. al (2016). Endometrial ablation: first-vs. second-generation techniques. Minerva Ginecol, 68(2), 143-153. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26928420/
- Famuyide, A. (2018). Endometrial ablation. Journal of Minimally Invasive Gynecology, 25(2), 299-307. doi: 10.1016/j.jmig.2017.08.656. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28888699/
- Gasner, A. & Aatsha, P. A. (2021). Physiology, Uterus. [Updated May 9, 2021] In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557575/
- Laberge, P., Leyland, N., Murji, A., Fortin, C., Martyn, P., Vilos, G., et al. (2015). Endometrial ablation in the management of abnormal uterine bleeding. Journal of Obstetrics and Gynaecology Canada, 37(4), 362-376. Doi: 10.1016/S1701-2163(15)30288-7. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1701216315302887
- Minalt, N., Canela, C. D., & Marino, S. (2021). Endometrial Ablation. [Updated May 4, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459245/
- Mishra, V., Verneker, R., Gandhi, K., Choudhary, S., & Lamba, S. (2018). Iron deficiency anemia with menorrhagia: Ferric carboxymaltose a safer alternative to blood transfusion. Journal of Mid-Life Health, 9(2), 92. doi: 10.4103/jmh.JMH_121_17. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006796/
- Wouk, N., & Helton, M. (2019). Abnormal uterine bleeding in premenopausal women. American Family Physician, 99(7), 435-443. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30932448/
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.