Endometrial Ablation

Rapid relief for small uterine fibroids and abnormal uterine bleeding

Endometrial ablation is a minimally invasive procedure used to treat small uterine fibroids and abnormal uterine bleeding.

During endometrial ablation, a thin layer of the inner lining of the uterus is removed. Your doctor may recommend endometrial ablation if your condition did not respond to other treatments such as hormone therapy or an intrauterine device (IUD).

Understanding Endometrial Ablation

Endometrial ablation is a minimally invasive procedure used to treat small uterine fibroids and abnormal uterine bleeding.

During endometrial ablation, a thin layer of the inner lining of the uterus is removed. Your doctor may recommend endometrial ablation if your condition did not respond to other treatments such as hormone therapy or an intrauterine device (IUD).

Endometrial ablation is a quick outpatient procedure that can be done at an outpatient clinic or in your doctor’s office.

You should not have endometrial ablation if you are past menopause, or if you have conditions such as:

  • Uterine or endometrial disorders
  • Endometrial hyperplasia
  • Uterine cancer
  • Recent pregnancy
  • Uterine infections

Having endometrial ablation

There are three kinds of endometrial ablation:

Radiofrequency ablation

During this procedure, your doctor inserts a probe with an expandable tip into the uterus through the vagina and cervix. The end of the probe carries a mesh-like device that opens inside the uterus and sends radiofrequency energy into the lining to destroy the endometrial tissue.

Heated balloon ablation

During this procedure, your doctor inserts a tool called a hysteroscope into the vagina and through the cervix into the uterus. The hysteroscope is used to place a balloon into the uterus and a heated fluid is pumped into the balloon. As the balloon expands, its edges touch the uterine lining, destroying it with heat.

Microwave energy ablation

During this procedure, your doctor inserts a special probe into the uterus through the vagina and cervix. The tool applies microwave energy to the uterine lining, which destroys it.

Risks of endometrial ablation

You should not have endometrial ablation if you are planning to get pregnant. Pregnancy after ablation carries a high risk of miscarriage and other problems because the uterine lining is removed. You will need to use some form of birth control after endometrial ablation until you complete menopause.

Other possible risks of endometrial ablation include:

  • Infection
  • Bleeding
  • Damage to the uterine wall or bowel
  • Burns from electrosurgery
  • Fluid used to expand the uterus during the procedure leaking into the bloodstream

What to Expect with Endometrial Ablation

Endometrial ablation is a quick outpatient procedure that can be done at an outpatient clinic or in your doctor’s office.

You should not have endometrial ablation if you are past menopause, or if you have conditions such as:

  • Uterine or endometrial disorders
  • Endometrial hyperplasia
  • Uterine cancer
  • Recent pregnancy
  • Uterine infections

Having endometrial ablation

There are three kinds of endometrial ablation:

Radiofrequency ablation

During this procedure, your doctor inserts a probe with an expandable tip into the uterus through the vagina and cervix. The end of the probe carries a mesh-like device that opens inside the uterus and sends radiofrequency energy into the lining to destroy the endometrial tissue.

Heated balloon ablation

During this procedure, your doctor inserts a tool called a hysteroscope into the vagina and through the cervix into the uterus. The hysteroscope is used to place a balloon into the uterus and a heated fluid is pumped into the balloon. As the balloon expands, its edges touch the uterine lining, destroying it with heat.

Microwave energy ablation

During this procedure, your doctor inserts a special probe into the uterus through the vagina and cervix. The tool applies microwave energy to the uterine lining, which destroys it.

Risks of endometrial ablation

You should not have endometrial ablation if you are planning to get pregnant. Pregnancy after ablation carries a high risk of miscarriage and other problems because the uterine lining is removed. You will need to use some form of birth control after endometrial ablation until you complete menopause.

Other possible risks of endometrial ablation include:

  • Infection
  • Bleeding
  • Damage to the uterine wall or bowel
  • Burns from electrosurgery
  • Fluid used to expand the uterus during the procedure leaking into the bloodstream

Before you have endometrial ablation, your doctor will:

  • check the size, shape and health of your uterus
  • remove an IUD, if you have one
  • take a biopsy of the lining of your uterus to make sure you do not have cancer

Other possible tests you may have before the procedure include:

  • Hysteroscopy: a thin telescope with a light (called a hysteroscope) used to see the inside of the uterus.
  • Ultrasonography: sound waves to create pictures of the pelvic organs.

You may need to stop taking medicines that reduce your blood’s ability to clot before having endometrial ablation. These include:

  • Aspirin
  • Ibuprofen
  • Naproxen
  • Clopidogrel
  • Warfarin

There are no incisions needed for endometrial ablation. You may receive general anesthesia or light sedation depending on which type of endometrial ablation procedure you undergo. If you will receive general anesthesia, you will not be able to eat or drink after midnight. Follow your doctor’s instructions the night before your procedure.

The Day of the Procedure

  • If your doctor prescribed medicine to open your cervix, take it as directed with a small sip of water.
  • You will be asked to change into a hospital gown after you arrive at the doctor’s office or hospital.
  • A nurse or technologist will attach devices to your body to monitor your heart rate and blood pressure.
  • You will also have an IV line inserted into a vein in your hand or arm so that you can receive sedative medicine. The sedative will make you feel relaxed and sleepy.
  • You may or may not remain awake during the procedure depending on how deeply you are sedated.
  • If the cervix will be dilated manually, the doctor will use a series of rods to gradually dilate your cervix.
  • Once the cervix is dilated, the doctor will insert a tool called a hysteroscope into the uterus through the vagina and cervix. The hysteroscope sends images of the inside of the uterus to a video monitor.
  • The doctor may use a gas or fluid to expand the uterus so he or she can better see the uterine lining.
  • Small tools can be used through the hysteroscope to remove abnormal growths or tissue for examination. Depending on the type of ablation used, heat or electricity will be applied to destroy the endometrial lining.
  • Your doctor will remove the tissue that is destroyed through your vagina.

If you receive general anesthesia, you will be moved to a recovery room after the procedure. A nurse will monitor your vital signs as you wake up. If you receive light sedation, you will relax in the doctor’s office until the sedation wears off. Recovery takes about two hours depending on the type of pain relief used.

You can expect frequent urination for 24 hours after the procedure. You may also experience nausea. Before you go home, your doctor will talk with you about when you can exercise, have sex or use tampons.

Preparing for Endometrial Ablation

Before you have endometrial ablation, your doctor will:

  • check the size, shape and health of your uterus
  • remove an IUD, if you have one
  • take a biopsy of the lining of your uterus to make sure you do not have cancer

Other possible tests you may have before the procedure include:

  • Hysteroscopy: a thin telescope with a light (called a hysteroscope) used to see the inside of the uterus.
  • Ultrasonography: sound waves to create pictures of the pelvic organs.

You may need to stop taking medicines that reduce your blood’s ability to clot before having endometrial ablation. These include:

  • Aspirin
  • Ibuprofen
  • Naproxen
  • Clopidogrel
  • Warfarin

There are no incisions needed for endometrial ablation. You may receive general anesthesia or light sedation depending on which type of endometrial ablation procedure you undergo. If you will receive general anesthesia, you will not be able to eat or drink after midnight. Follow your doctor’s instructions the night before your procedure.

The Day of the Procedure

  • If your doctor prescribed medicine to open your cervix, take it as directed with a small sip of water.
  • You will be asked to change into a hospital gown after you arrive at the doctor’s office or hospital.
  • A nurse or technologist will attach devices to your body to monitor your heart rate and blood pressure.
  • You will also have an IV line inserted into a vein in your hand or arm so that you can receive sedative medicine. The sedative will make you feel relaxed and sleepy.
  • You may or may not remain awake during the procedure depending on how deeply you are sedated.
  • If the cervix will be dilated manually, the doctor will use a series of rods to gradually dilate your cervix.
  • Once the cervix is dilated, the doctor will insert a tool called a hysteroscope into the uterus through the vagina and cervix. The hysteroscope sends images of the inside of the uterus to a video monitor.
  • The doctor may use a gas or fluid to expand the uterus so he or she can better see the uterine lining.
  • Small tools can be used through the hysteroscope to remove abnormal growths or tissue for examination. Depending on the type of ablation used, heat or electricity will be applied to destroy the endometrial lining.
  • Your doctor will remove the tissue that is destroyed through your vagina.

If you receive general anesthesia, you will be moved to a recovery room after the procedure. A nurse will monitor your vital signs as you wake up. If you receive light sedation, you will relax in the doctor’s office until the sedation wears off. Recovery takes about two hours depending on the type of pain relief used.

You can expect frequent urination for 24 hours after the procedure. You may also experience nausea. Before you go home, your doctor will talk with you about when you can exercise, have sex or use tampons.

Recovery

If your doctor took samples of uterine tissue during the ablation procedure, your biopsy results will be available within one or two weeks. Your doctor will share the results with you and talk to you about what they mean.

Because you retain your reproductive organs, you will still need routine Pap tests and pelvic exams after an endometrial ablation procedure. If ablation does not control your uterine fibroid symptoms, you may need additional treatment or surgery.

Your recovery at home

Once you are home, you may experience some minor side effects, including menstrual-like cramping for one or two days and a watery discharge mixed with blood, which can last a few weeks.

Be sure to follow your doctor’s instructions about when you can exercise, have sex or use tampons. In most cases, you can return to work and your normal activities within a day or two.

Your doctor will schedule a follow-up visit about three months after the ablation procedure to check your progress. It can take several months to experience the full effects of ablation. After you have recovered, you may notice lighter than normal menstrual bleeding or your period may stop altogether.

After Your Procedure

Recovery

If your doctor took samples of uterine tissue during the ablation procedure, your biopsy results will be available within one or two weeks. Your doctor will share the results with you and talk to you about what they mean.

Because you retain your reproductive organs, you will still need routine Pap tests and pelvic exams after an endometrial ablation procedure. If ablation does not control your uterine fibroid symptoms, you may need additional treatment or surgery.

Your recovery at home

Once you are home, you may experience some minor side effects, including menstrual-like cramping for one or two days and a watery discharge mixed with blood, which can last a few weeks.

Be sure to follow your doctor’s instructions about when you can exercise, have sex or use tampons. In most cases, you can return to work and your normal activities within a day or two.

Your doctor will schedule a follow-up visit about three months after the ablation procedure to check your progress. It can take several months to experience the full effects of ablation. After you have recovered, you may notice lighter than normal menstrual bleeding or your period may stop altogether.

Patient Stories for Endometrial Ablation