Endometrial Ablation

Understanding Endometrial Ablation

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).

Risks of Endometrial Ablation

You should not have an endometrial ablation if you are past menopause (no menstrual period for 12 consecutive months), or if you have conditions such as:

• Unexplained uterine bleeding
• Endometrial hyperplasia
• Uterine cancer
• Recent pregnancy
• Uterine infections

You should not have an 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

Preparing for Endometrial Ablation

Before you have an endometrial ablation, your doctor may:

• Check the size, shape and health of your uterus
• Remove an IUD, if you have one
• Take an endometrial biopsy of the lining of your uterus to make sure you do not have cancer

Your doctor may use specialized technology before or during the procedure:

• Hysteroscopy: a thin instrument 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 an 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 receive general anesthesia, you will not be able to eat anything after midnight prior to the procedure. You may be able to take very small sips of clear liquids, such as water, electrolyte drinks, black tea or black coffee, up to 2 hours before surgery. Follow your doctor’s instructions the night before your procedure.

The Day of the Procedure

On the day of your procedure, you can expect: 

• 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 is dilated manually (instead of through medicine), 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 will use a 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.

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 anesthesia used.

You can expect to urinate frequently 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.

Endometrial Ablation 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 this procedure keeps your reproductive organs intact, you will still need routine Pap tests and pelvic exams after an endometrial ablation procedure. If ablation does not control your 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 a day or two 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 two to six weeks after the ablation procedure to check your progress. It can take up to six 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.