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Endometrial ablation is a surgical procedure used to treat women suffering from excessive or prolonged menstrual bleeding and who have not responded to other treatments such as medication. Endometrial ablation removes or destroys the uterine lining, or endometrium, while leaving the ovaries and uterus intact. The endometrium heals by scarring, which reduces or stops future uterine bleeding.
Types Of Endometrial Ablation
There are several different methods of endometrial ablation. Most methods are performed under local or general anesthesia and a hysterscopy to examine the uterine area is commonly performed prior to the endometrial ablation procedure. Common methods of endometrial ablation may include:
Hydrothermal Endometrial Ablation
Hydrothermal endometrial ablation or HTA, uses heated water to destroy the lining of the uterus.Water is heated to 194 degrees and directed into the uterus using a pump device. The water is flushed through the uterus, carefully monitored at all times to ensure it does not enter the fallopian tubes, and drained after approximately 10 minutes.
Microwave Energy Endometrial Ablation
With microwave energy endometrial ablation, a probe is inserted into the uterus through the cervix and it applies microwave energy to the uterine lining, which destroys it.
Freezing Endometrial Ablation
A thin probe is inserted through the cervix and the end of the probe freezes the uterine lining.
Radio Frequency Endometrial Ablation
A probe is inserted through the cervix that emits radio frequency and heat which destroy the uterine lining. Suction is used to remove the destroyed tissue.
After some of the treatments that do not use suction to remove the destroyed tissue, the treated endometrial lining will naturally break down as it would during a typical menstrual period within a few weeks.
Am I a good candidate for endometrial ablation?
If you suffer from excessive menstrual bleeding, endometrial ablation could be a good procedure. This would be menstrual bleeding that is heavy enough to get in the way of everyday life. At Craig Ranch, our gynecologists could recommend endometrial ablation if you have:
- Unusually heavy periods, where you are soaking a pad or tampon within two hours or less
- Bleeding that lasts longer than eight days
- Anemia from excessive blood loss
Who should not have endometrial ablation?
If you are pregnant or want to get pregnant, you should not have this procedure, as it will make it more difficult for you to get pregnant moving forward.
These conditions would also preclude a person from having endometrial ablation:
- Uterine, cervical, or endometrial cancer
- Pelvic inflammatory disease
- A vaginal or cervical infection
- A weak wall to your uterus
- An infection of the uterus
- A scar from a Caesarean section
- An intrauterine device
- A disorder of the uterus or endometrium
What are the benefits of endometrial ablation?
These procedures usually work to effectively reduce bleeding. About 10 percent of patients who undergo endometrial ablation stop menstruation altogether. Women who have painful periods or suffer from pre-menstrual syndrome also usually have significant improvement.
Risks Of Endometrial Ablation
Although it is considered a common and safe procedure, there are risks of endometrial ablation which may include:
- Burns to the vagina, vulva or bowel when using methods that use heat
- Fluid entering the bloodstream
Patients should discuss all risks with their doctor before deciding whether endometrial ablation is the right treatment for their condition.
Is an endometrial ablation painful?
Patients are anesthetized during these procedures, so there is no pain. The form of anesthesia depends upon the type of endometrial ablation we are performing. After your procedure, you may have some cramping and bleeding. It’s also common to have nausea and an urge to urinate for the first 24 hours. Any pain can be managed with over-the-counter medications, but don’t use aspirin because it can increase bleeding.
Recovery From Endometrial Ablation
After endometrial ablation, most patients experience cramping for up to two days and a watery discharge that may last a few weeks. Most normal activities may be resumed the following day, with the exception of tampon use and sexual activity.
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How long will my results from endometrial ablation last?
It may take between 8 and 12 months to be certain of the effects of your endometrial ablation. In most women, these are permanent results. As mentioned above, about 10 percent of patients who have endometrial ablation stop menstruation completely. In a further 70 percent, bleeding is effectively reduced permanently. Period pain and PMS symptoms are typically improved dramatically. In women under age 40, however, menstruation may return.
Overall, between 70 to 80 percent of women who have endometrial ablation are satisfied with the procedure and their results.
Can I get a second endometrial ablation?
The results of endometrial ablation aren’t always permanent. In some women, particularly those under the age of 40, menstruation may return. It is possible to have a second procedure, but we will also discuss alternative treatments including hysterectomy.
Can I still get pregnant after an endometrial ablation?
Endometrial ablation is not a sterilization procedure, but you should not have it if you want to have a baby in the future. Women who have this and stop menstruating are quite unlikely to get pregnant. But in all cases, there is still a chance of pregnancy so patients should continue with contraception until they have reached menopause. Any pregnancy that would result could be hazardous and would likely end in miscarriage.