During menstruation, the lining of the uterus – the endometrium – is shed, resulting in various levels of bleeding. Some women experience heavy bleeding, or menstruation periods that last longer than normal. Many seek treatment to control this, usually beginning with medication. If heavy bleeding cannot be controlled with medication, endometrial ablation – the destruction of the endometrium – might be a good alternative. Although the surgery usually results in stopping menstrual bleeding, some women will experience lighter or shorter periods instead.
Candidates
Women seeking to control their heavy bleeding or prevent pregnancy are good candidates for endometrial ablation. However, if a small piece of the endometrium remains after the procedure, a complicated pregnancy can still occur, so birth control is still recommended.
Endometrial ablation is not recommend for women past menopause, or those with serious medical conditions, including:
- Disorders of the uterus or endometrium
- Endometrial hyperplasia
- Cancer of the uterus
- Recent pregnancy
- Recent or current uterine infection
Please note that a woman who has undergone endometrial ablation retains her reproductive organs, and thus pap tests and pelvic exams are still necessary.
In-office Surgery
At Alliance OBGYN, Endometrial ablation is done as an outpatient surgery or in our clinic, usually with local anesthesia, though sometimes general anesthesia is used. Some patients will need to have their cervix dilated before the procedure, which can be done via medication or a series of rods of increasing size. As there are no incisions involved, recovery time can be as little as two hours, depending on the method and the type of pain relief medication.
The following are some of the most popular methods of endometrial ablation:
- Freezing: A thin probe, inserted through the uterus and guided by the doctor using ultrasound, freezes the lining of the uterus.
- Radiofrequency: The tip of a probe inserted through the uterus expands into a mesh-like device; the radiofrequency energy and heat released by the probe destroys the lining, and suction is used to remove it.
- Microwave: Microwave energy applied by a probe destroys the uterine lining.
- Heated fluid: Using a hysteroscope (a lighted viewing instrument), heated saline solution is inserted into the uterus, where it remains for approximately ten minutes. The heat destroys the endometrium.
- Heated balloon: A balloon is inserted into the uterus, where it is filled with heated saline solution. It expands until it touches the uterine lining, and the heat destroys endometrium.
- Electrosurgery: This procedure utilizes a resectoscope, a device with an electrical wire loop, roller ball, or spike-ball tip that destroys the uterine lining. Electrosurgery is used less frequently than the other methods.
Risks
Problems resulting from endometrial ablation are uncommon, but can be severe. They include:
- Accidental puncture of the uterus
- Burns to the uterus or the bowel
- Buildup of fluid in the lungs (pulmonary edema)
- Sudden blockage of blood flow in the lungs (pulmonary embolism)
- Accidental laceration of the cervix
After the Surgery
Side effects are largely minor, and include the following:
- Cramping, similar to menstrual cramps, for 1-2 days
- A thin discharge, water mixed with blood, that lasts up to a few weeks
- Frequent urination for 24 hours
- Nausea
Most women will have reduced menstrual flow after ablation, and some may even stop menstruating altogether. However, younger women are less likely to respond than older women, and some younger women will need a repeat procedure. They are often treated with gonadotropin-releasing hormones one to three months before surgery in order to thin the uterine lining, but the surgery may still not be completely successful.
If you are experiencing heavy bleeding or menstruation periods that are longer than normal and see if you are a candidate for endometrial ablation, please schedule an appointment with Alliance OBGYN Associates by calling 856-320-5069
