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 radiofrequency 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.
How Long Does it Take to Fully Recover from Endometrial Ablation?
You may feel much like your normal self after a few days to a week of rest and recovery following endometrial ablation. That said, regardless of how good you feel, it's imperative that you follow your post-treatment instructions carefully.l Do not pull, push, or lift heavy objects for at least two weeks. To be fully recovered from endometrial ablation means that you've passed the time in which the risk of internal bleeding exists. This usually takes just two weeks, after which you may receive clearance from your doctor for all of your normal activities, including sexual intercourse.
What if I Notice Pelvic Pain or Abnormal Bleeding After Endometrial Ablation?
There is a possibility of minor discomfort during your recovery from endometrial ablation. However, you should not experience notable pelvic pain or continued abnormal bleeding. These symptoms could indicate that scar tissue has developed in the uterus. Scar tissue can distort the structure of the uterus, creating challenges that require further diagnostic testing and treatment. If pain and abnormal bleeding or, conversely, obstruction to menstrual flow, occur due to the formation of scar tissue in the uterine cavity, your doctor may recommend that you undergo a hysterectomy. According to studies, patients treated with endometrial ablation typically receive predictable results that last up to seven years. After that point, the chances of needing a hysterectomy increase.
Will I Need Hormone Therapy after Endometrial Ablation?
You will not need to take hormones after having endometrial ablation, no. This procedure works by affecting the uterine lining. It has no effect on the ovaries so does not interrupt your normal hormone cycle.
Will Endometrial Ablation Cause Early Menopause?
You will not enter early menopause as a result of endometrial ablation treatment. Your hormone function will continue normally so you can expect to maintain regular periods, just less intense than they were before treatment.
Should I Just Get a Hysterectomy for Abnormal Menstrual Bleeding?
Because there is a chance that some women will have a hysterectomy at some point after endometrial ablation, many patients wonder if they should skip the minimally invasive procedure and simply put an end to their periods once and for all. This is a personal choice, but it's one that should be made with considerable exploration of the pros and cons of each approach to heavy menstrual bleeding.
Endometrial ablation is used to treat heavy menstrual bleeding, bleeding in between periods, or prolonged periods. It may also be advantageous for women who've developed anemia as a result of heavy periods. Hysterectomy surgery can address these problems and many more, including various cancers. When comparing these two treatment options for the purpose of ending heavy menstrual bleeding, we look at the complexity of the procedure itself, the potential surgical outcome, and the amount of time and degree of risk involved in recovery.
Side by side, hysterectomy and endometrial ablation have quite a few differences. Hysterectomy is a more invasive procedure and is considered a major surgery. This means there are higher risks associated with it and more downtime. That said, heavy menstrual bleeding is eliminated because menstruation stops. Depending on the circumstances, though, it may be necessary to take hormone therapy for up to several years after the uterus is removed. Endometrial ablation isn't designed to stop menstruation, although sometimes this does happen. Performed using minimally invasive techniques, ablation requires little downtime and harbors fewer risks.
If you're questioning which procedure is right for you, consult with an experienced OBGYN. Here in our McKinney, TX practice, you can expect to receive a thorough explanation of recommended procedures, helping you make a confident decision about your treatment of choice.
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