Endometrial Ablation

Endometrial ablation is a procedure in which the endometrium (the tissue lining the inside of the uterus that grows and sheds during the menstrual cycle) is burned with a specific device or tool. The goal of endometrial ablation is to significantly decrease the amount of bleeding experienced during a menstrual cycle or even to eliminate bleeding.

Endometrial ablation can be performed in the office with moderate sedation or in the operating room under general anesthesia. Either way, you are able to go home the same day.

First, I will use a hysteroscope to evaluate the inside of the uterus. If any polyps or fibroids are present, these are removed first. This initial inspection is also to make sure the shape of the uterus is compatible with the planned endometrial ablation device or chosen technique. (For example, a heart-shaped uterus, also known as a bicornuate uterus, would not be a good candidate for a global array device.)

Endometrial ablation is an excellent procedure, but is not for everyone.

The ideal candidate for endometrial ablation is someone in their mid- to late 40s (about 5-7 years from menopause) who is experiencing heavy menstrual bleeding and wants to avoid surgery that needs recovery time. 60% of these women will successfully achieve amenorrhea (no period bleeding). Most of the other women have significantly improved bleeding patterns and are satisfied with the results.

The data regarding “success rates” after endometrial ablation followed women for 5 years. If an endometrial ablation is done in the early 40s or earlier, you may need additional treatment later on. 

Women with history of chronic pelvic pain, adenomyosis, or severe dysmenorrhea (painful cramping during menses) are likely not good candidates for endometrial ablation. Based on the research regarding this procedure, women with chronic pelvic pain, adenomyosis, or severe dysmenorrhea may experience worsening of their symptoms associated with those conditions. 

In addition, women who have had a tubal ligation are likely not excellent candidates for endometrial ablation either. A small percentage of women (5%) who have had tubal ligation before, or in combination with endometrial ablation, develop severe pelvic pain. This has been termed Post-ablation Tubal Ligation syndrome (PATL syndrome). For this reason, I don’t recommend this combination of procedures.

There is one important consideration regarding endometrial ablation to note. Because the endometrium is completely ablated, obtaining a biopsy of the endometrium in the future is challenging, if not impossible. Women with risk factors for endometrial cancer, continued heavy menstrual bleeding, or who develop post-menopausal bleeding need an endometrial biopsy to rule out cancer. Because of the unreliability of biopsy after endometrial ablation, women with multiple risk factors for endometrial cancer should carefully consider their options before selecting endometrial ablation.