Indication

Endometrial ablation treats excessive menstrual blood loss, which may be indicat
ed by:
?Unusually heavy periods most months
?Enough blood loss to soak through a pad or tampon every hour on the heaviest da
ys
?Anemia from excessive blood loss
?Bleeding has not responded to other treatments due to a benign (non-cancerous)
condition..
?Childbearing is completed.
?Pt prefer not to have a hysterectomy to control bleeding.
?Other medical problems prevent a hysterectomy.
Several options exist to help reduce menstrual bleeding. Doctors may prescribe m
edications or a progesterone-releasing intrauterine device (IUD) as the first li
ne of treatment for heavy menstrual bleeding, but endometrial ablation may be an
option if medications or an IUD don't help.
Contraindications:
Endometrial ablation is not recommended for women who:
?Wish to become pregnant in the future
?Have significant cramping with menstrual periods
?Have cancer of the uterus since cancer cells may have grown into the deeper tis
sues of the uterus and can't often be removed by the procedure.
?Were recently pregnant
?Are past menopause
How Well It Works
Most women will have reduced menstrual flow following endometrial ablation. And
up to half will stop having periods.1
Younger women are less likely than older women to respond to endometrial ablatio
n. After an endometrial ablation, younger women are more likely to continue to h
ave periods and need a repeat procedure.
Young women may be treated with gonadotropin-releasing hormone analogues (GnRH-A
s) 1 to 3 months before the procedure. This will decrease their production of es
trogen and help thin the lining of the uterus (endometrium).
Risks
Problems that can happen during endometrial ablation include:
?Accidental puncture (perforation) of the uterus.
?Burns (thermal injury) to the uterus or the surface of the bowel.
?fluid used to expand the uterus during the procedure can be absorbed into the b
loodstream pulmonary edema.
?Sudden blockage of arterial blood flow within the lung (pulmonary embolism).
?Tearing of the opening of the uterus (cervical laceration).
?Pain, bleeding or infection
These problems are uncommon but can be severe.
What To Think About
Regrowth of the endometrium may occur after you have endometrial ablation. This
procedure is not recommended if you have a high risk for endometrial cancer.
Do not consider this procedure if you plan to become pregnant in the future.
Although this surgery usually causes sterility by destroying the lining of the u
terus, pregnancy may still be possible if a small part of the endometrium is lef
t in place. This can lead to severe pregnancy problems. Birth control of some fo
rm is needed if you have not finished menopause.
Future fertility
After endometrial ablation, pregnancy is still possible in some women. However,

these pregnancies may be higher risk to both mother and baby. The pregnancy
end in miscarriage because the lining of the uterus has been damaged. Women
want to become pregnant in the future should not have endometrial ablation.
women choose a sterilization procedure at the time of endometrial ablation
revent pregnancy.

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Endometrial ablation procedures vary by the method used to destroy your endometr
ium. Options include:
?Electrosurgery. This method uses a slender scope to see into the uterus during
the procedure. An instrument passed through the scope for instance, a roller ball
, spiked ball or wire loop becomes hot and is used to carve furrows into the endo
metrium. Electrosurgery requires general anesthesia and generally takes 30 minut
es or less to complete.
?Extreme cold. Cryoablation uses extreme cold to create two or three ice balls t
hat freeze and destroy the endometrium. Real-time ultrasound allows the doctor t
o track the progress of the ice balls. Each freeze cycle takes up to 6 minutes t
o complete; the number of cycles needed depends on the size and shape of your ut
erus.
?Free-flowing hot fluid. Saline fluid heated to 176 to 194 F (80 to 90 C) is cir
culated within the uterus for about 10 minutes. This method can be more painful
than other office-based methods, but it's the method most likely to get complete
coverage.
?Heated balloon. A balloon device is inserted through your cervix and then infla
ted with fluid heated to 188.6 F (87 C). The balloon helps prevent fluid from es
caping up the fallopian tubes, but the balloon sometimes isn't flexible enough t
o contact the entire endometrium. This method takes about 10 minutes to complete
.
?Microwave. In this method, the doctor inserts a slender wand that emits microwa
ves, which elevate the temperature of the endometrial tissue to 167 to 185 F (75
to 85 C). The doctor moves the wand from side to side while pulling it out of t
he uterus. Total treatment time is usually three to five minutes.
?Radiofrequency. A more automated method of endometrial ablation uses an instrum
ent that unfurls a mesh electrode array within the uterus. The mesh transmits ra
diofrequency energy that vaporizes the endometrial tissue within 80 to 90 second
s.
After endometrial ablation, you may experience:
?Cramps. You may have menstrual-like cramps for a few days. Over-the-counter med
ications such as ibuprofen or acetaminophen can help relieve cramping after the
procedure.
?Vaginal discharge. A watery discharge, mixed with blood, may occur for a few we
eks. The discharge is typically heaviest for the first few days after the proced
ure.
?Frequent urination. You may need to pass urine more often during the first 24 h
ours after endometrial ablation.
You may need to avoid intercourse and tampon use for a period of time after the
procedure. Ask your doctor how long you should wait before resuming these activi
ties.
The majority of women who undergo endometrial ablation report a successful reduc
tion in abnormal bleeding. Up to half of women will stop having periods after th
e procedure. Yet, studies indicate the rate of failure (defined as bleeding or p
ain after endometrial ablation that required hysterectomy or reablation) was 16%
to 30% at 5 years. Failure was most likely to occur in women younger than 45 ye
ars and in women with 5 or more children, prior tubal ligation, and a history of
painful menstrual cramps. After endometrial ablation, 11% to 36% of women had a
repeat ablation or other uterine-sparing procedure.