Endometrial Ablation

About Endometrial Ablation

Endometrial ablation destroys the lining of the uterus, the endometrium, to reduce heavy menstrual bleeding, offering a less invasive alternative to hysterectomy for people who have completed childbearing. Earlier techniques used a hysteroscope with a rollerball, loop or laser under direct vision, while modern global ablation devices treat the whole cavity at once using a heated fluid filled balloon, bipolar radiofrequency energy, freezing, microwave energy or circulating hot saline. Many patients experience a substantial reduction in bleeding and high satisfaction, while a smaller proportion stop menstruating altogether. Assessment before the procedure includes sampling of the endometrium to exclude cancer or precancerous hyperplasia and evaluation of the uterine cavity, since large fibroids or an abnormal shape can make treatment less effective. Many global devices can be used in an outpatient or office setting under local anesthesia or light sedation. The procedure is not suitable for people who wish to become pregnant, those with endometrial hyperplasia or cancer, or those with active pelvic infection. Ablation is not a form of contraception, and pregnancy after ablation is associated with serious complications, so contraception or sterilization is often discussed at the same time. Complications are uncommon and include perforation of the uterus, infection and thermal injury to nearby organs. Late problems include cyclical pain from blood trapped behind scar tissue, including post ablation tubal sterilization syndrome in people who have had tubal ligation. Some patients later undergo hysterectomy for persistent bleeding or pain, and scarring can make later evaluation of the endometrium more difficult.