Guide To Menstruation
Reproductive System Disorders
|What Is Endometrial Ablation?
It is a procedure that destroys a thin layer of the uterus (womb) called the endometrium lining. This lining breaks down every month as part of a woman's menstrual cycle resulting in menstrual bleeding. After endometrial ablation is performed, the endometrium heals by scarring. This scar tissue no longer breaks down in the same way and so bleeding is either prevented or significantly reduced.
Endometrial ablation is used to treat abnormal (excessive or prolonged) menstrual bleeding in women who do not wish to undergo a hysterectomy. Endometrial ablation is not a first line treatment. Prior to recommending ablation, your doctor may prescribe hormone drugs (GnRH agonists) or a progesterone-releasing IUD device to control periods. If these fail to lighten periods and your quality of life continues to be affected, ablation may be suggested. In some women, ablation stops periods altogether, in others, heavy periods are reduced to lighter levels. If ablation does not work, further treatment or surgery may still be required.
When Is It Recommended?
It may be recommended to treat persistent heavy periods which result in excessive menstrual blood loss (a condition called Menorrhagia). Signs of menorrhagia could be soaking a pad or tampon every hour for more than 3 hours, or bleeding for longer than 7 days. Menorrhagia is more common in women with gynecological disorders such as endometriosis and adenomyosis.
When Is It Not Recommended?
It is not recommended for women who:
• Want to become pregnant in the future.
• Have uterus cancer.
• Have endometrial hyperplasia.
• Has any disorders of the endometrium or uterus, including infection.
• Were recently pregnant.
• Suffer from significant menstrual cramping with their periods.
• Are postmenopausal (periods have stopped for at least 12 months).
• About 90 percent of women who undergo endometrial ablation have reduced menstrual bleeding.
• 45 percent stop having periods altogether.
• A hysterectomy is still required in 22 percent of cases.
The surgery is less effective in younger women who are more likely than older women to continue having periods and require a repeat procedure. To improve their success rate, younger women may be prescribed hormone medications called gonadotropin-releasing hormone analogues (GnRH agonists) for up to 3 months before surgery to help thin the lining of their womb.
Can I Still Get Pregnant After Endometrial Ablation?
It is not likely, although it can happen. Furthermore, women who do become pregnant are at greater risk for miscarriage and pregnancy complications resulting from a compromised womb. If you still wish to become pregnant, you should not have this procedure. Premenopausal women who undergo endometrial ablation should still use birth control as a precaution until menopause. Regular pap test and pelvic examination are still required after the procedure. Read about recommended screenings for women at all ages.
How Is It Performed?
Different surgical tools can be used to destroy the lining of the womb (endometrium). Some types apply extreme cold, others heat, thermal laser or high energy radiofrequencies. Some techniques can be performed in a doctors office under local anesthetic, while others must be done in a surgery room under general anesthesia. The size and condition of your womb will determine which technique is best for you.
A probe is inserted through the vagina and cervix into the womb. Once in place the tip of the probe expands into a mesh-like device and emits radiofrequency energy into the endometrium. The energy kills the tissue within 90 seconds and suction is used to remove it.
A probe is inserted into the womb and the tip of the probe freezes the lining, killing the tissue. Ultrasound is used to guide the procedure.
A saline fluid is inserted into the uterus via a hysteroscope. The fluid is then heated (176 to 194 F) and remains circulating in the uterus for about 10 minutes. The heat destroys the endometrial tissue. It can be more painful than other methods but it is more likely to achieve full coverage. An alternative methods involves inserting a balloon into the uterus with a hysteroscope. Once the balloon is in place, heated fluid is injected into it. The balloon expands and the edges touch the lining of the uterus, destroying it. The main benefit of the balloon is that the fluid is contained so it is less likely to leak into the bloodstream or nearby organs such as the fallopian tubes. On the downside, it is not always flexible enough to touch all the surface of the womb.
A probe is inserted through the vagina and cervix into the womb. Microwave energy is emitted through the probe, destroying the uterus lining. It takes about 5 minutes to perform.
Requires general anesthesia and takes about 30 minutes to perform.
A thin telescopic device called a resectoscope is inserted into the uterus. The tip of the scope has an electrical wire loop, spiked ball or roller-ball attached which destroys the endometrium. Electrosurgery is performed less frequently than other methods.
Recovery After Surgery
Most patients can return home the same day. Some minor side effects are common and can last from a few days to 2 weeks. These include:
• Cramping, like a period pain for 1 to 2 days. You may be given ibuprofen to take for 48 hours.
• Thin watery discharge with some blood, like a light period. It may be heavy for 2 to 3 days and gradually disappears after 4 weeks. While bleeding, use sanitary towels rather than tampons as tampons increase your risk of infection.
• Need to urinate frequently for first 24 hours.
Average Recovery Time
It is advisable to refrain from heavy work or vigorous exercise for a few days until your body has healed. Most women return to work and normal activities within 2 to 5 days after surgery. However, you should wait until all discharge has stopped before resuming sexual intercourse.
What Are The Risks And Complications?
There are certain risks with this procedure including:
• Small risk of infection and bleeding.
• The surgical tool may accidentally puncture (perforate) the wall of the womb or bowel.
• Depending on which technique is used, the vagina, vulva or bowel may be burned.
• Rarely fluid leaks into the bloodstream causing pulmonary edema (highly dangerous). To prevent this problem, the amount of liquid used is carefully monitored.
• The endometrium lining can grow back, further treatment may be necessary.
When To Contact The Doctor
Contact your doctor if you develop any of the following symptoms after your operation:
• Burning or stinging with urination. You may have developed a urinary tract infection which needs treatment with antibiotics.
• Heavy or prolonged bleeding: in addition to fever (high temperature) and general feeling of unwellness. You may have developed a uterus infection which needs antibiotics. Occasionally these will need to be given by IV drip in hospital.
• Pain in lower tummy: if you have a pain in the lower abdomen, particularly if accompanied by fever, this is a sign of a more serious complication.
How Much Does It Cost?
The cost of endometrial ablation depends on which procedure is performed - less complicated techniques performed in a doctor’s office cost on average $2,700. In hospital, including anesthesia fee, this rises to about $5,500.
I had endometrial ablation done a few months ago. Before I had it, I did lots of research on the internet and couldn’t find anything negative about it. It seemed to be the miracle cure for heavy painful periods. I didn't want to go down the route of taking hormones, tried it before and all they did was cause weight gain and depression. It's been 6 months since I had ablation. Before, my periods were heavy and lasted about 5 days. Now, I still have them, they are lighter (good!), but they last 9 days instead of 5. I get worse back pain and cramps than I used to and I get spotting between periods. I'm 35, and thought it would be a miracle cure. Instead, I'm worse than ever.
I had endometrial ablation 6 weeks ago, I'm 42 and have 4 kids. I'm already starting to wish I chose the partial hysterectomy instead. Although bleeding seems to have stopped, I have this awful constant back pain, as bad as labor pain.
I have mixed feelings about my surgery; I had it done 4 years ago when I was 46. I would do it again, it did stop my periods. Before, bleeding really interfered with my life. I couldn’t go anywhere without a stack of towels, and I was always scared of an 'accident'. After surgery, my periods reduced to 5 manageable days a month and completely stopped after 5 months. I began to live again. The reason why I have mixed feelings, is because of the pain surgery caused. When I woke up, I have never experienced such pain in my life. I was heavily medicated and sent home - but it lasted for 5 days. It was so bad, had I known, I'm not sure would I have gone through with it.
I had the surgery 8 days ago - I didn't have any of the pain that others mention after it. I'm still spotting but that's to be expected. Before having surgery I shopped around and got a second opinion. I didn't let my regular gynecologist do it, instead I went to a specialist who has already performed on 500 other women. Not sure if that has something to do with my better experience.
I had ablation done at the age of 46 and experienced some mild cramping after. My periods got lighter and eventually stopped coming altogether. The only weird side effect that I had was a sort of burning odor from my vagina. The doctor told me it would go away, but 5 years later it is still there. Also, I get a mild pain sometimes down the right side of my back.