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Endometrial ablation

Endometrial ablation is a surgery or procedure done to damage the lining of the uterus in order to minimize heavy or prolonged menstrual flow. This lining is called the endometrium.

Description

Most often, a tool called a hysteroscope is used. It is a thin, lighted tube. It sends images of the inside of the womb to a video monitor.

  • Most times, the procedure is performed under general anesthesia, but sometimes it is performed in the office under light sedation.
  • The health care provider places the scope through the vagina and cervix and into the womb.
  • Gas or fluid may be placed into the womb so it expands. This helps the provider see the area better.
  • Pictures of the womb can be seen on the video screen.

Small tools can be used through the scope to remove abnormal growths or tissue for examination. Ablation uses heat, cold, or electricity to destroy the lining of the womb.

The procedure takes about 45 minutes.

Why the Procedure is Performed

This procedure can treat heavy or irregular periods. Your doctor will likely have tried other treatments first, such as hormone medicines or an IUD.

Endometrial ablation will not be used if you may want to become pregnant in the future. Though this procedure does not prevent you from getting pregnant, it may reduce your chances of getting pregnant. Reliable contraception is important in all women who get the procedure.

If a woman gets pregnant after an ablation procedure, the pregnancy will often miscarry or be extremely high risk because of the scar tissue in the uterus.

Risks

Risks of hysteroscopy include:

  • Hole (perforation) in the wall of the womb
  • Scarring of the lining of the womb
  • Damage to the cervix
  • Need for surgery to repair damage

Risks of any pelvic surgery include:

  • Damage to nearby organs or tissues
  • Blood clots, which could travel to the lungs and be deadly (rare)

Risks of anesthesia include:

  • Nausea and vomiting
  • Dizziness
  • Headache
  • Breathing problems
  • Lung infection

Risks of any surgery include:

  • Infection
  • Bleeding

Before the Procedure

A biopsy of the endometrium or lining of the uterus will be performed in the weeks prior to the procedure. Younger women may be treated with a hormone that blocks estrogen from being made by the body for 1 to 3 months before the procedure.

Your health care provider may prescribe medicine to open your cervix. This makes it easier to insert the scope. You need to take this medicine about 8 to 12 hours before your procedure.

Before any surgery:

  • Always tell your provider about all the medicines you take. This includes vitamins, herbs, and supplements.
  • Tell your provider if you have diabetes, heart disease, kidney disease, or other health problems.

In the 2 weeks before your procedure:

  • You may need to stop taking drugs that make it hard for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), clopidogrel (Plavix), and warfarin (Coumadin). Your provider will tell you what you should or should not take.
  • Ask your provider which medicines you can take on the day of your procedure.
  • Tell your provider if you have a cold, flu, fever, herpes outbreak, or other sickness.
  • You will be told when to arrive at the hospital. Ask if you need to arrange for someone to drive you home.

On the day of the procedure:

  • You may be asked not to drink or eat anything 6 to 12 hours before your procedure.
  • Take any approved drugs with a small sip of water.

After the Procedure

You may go home the same day. Rarely, you may need to stay overnight.

  • You may have menstrual-like cramps and light vaginal bleeding for 1 to 2 days. Ask your provider if you can take over-the-counter pain medicine for the cramping.
  • You may have a watery discharge for up to several weeks.
  • You can return to normal daily activities within 1 to 2 days. Do not have sex until your provider says it is OK.
  • Any biopsy results are usually available with 1 to 2 weeks.

Your doctor will tell you the results of your procedure.

Outlook (Prognosis)

The lining of your uterus heals by scarring. Women will most often have less menstrual bleeding after this procedure. Up to 30 to 50% of women will completely stop having periods. This result is more likely in older women.

Alternative Names

Hysteroscopy-endometrial ablation; Laser thermal ablation; Endometrial ablation-radiofrequency; Endometrial ablation-thermal balloon ablation; Rollerball ablation; Hydrothermal ablation; Novasure ablation

References

Lentz G. Endoscopy: Hysteroscopy and laparoscopy: Indications, contraindications and complications. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 10.

Review Date 11/25/2014

Updated by: Cynthia D. White, MD, Fellow American College of Obstetricians and Gynecologists, Group Health Cooperative, Bellevue, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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