Endometrial Ablation

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Medical Author:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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What is endometrial ablation?

Endometrial ablation is the surgical destruction of the lining tissues of the uterus, known as the endometrium. Endometrial ablation is one type of treatment for abnormal uterine bleeding.

Why is endometrial ablation done?

Endometrial ablation is a treatment for abnormal bleeding of the uterus that is due to a benign (non-cancerous) condition. Endometrial ablation is not sufficient for treatment of bleeding due to cancer of the uterus, since cancer cells may have grown into the deeper tissues of the uterus and would not be removed by the procedure.

Endometrial ablation is only performed on a nonpregnant woman who does not plan to become pregnant in the future. It should not be performed if the woman has an active infection of the genital tract. Endometrial ablation is not a first-line therapy for heavy bleeding and should only be considered when medical and hormonal therapies have not been sufficient to control the bleeding.

How is endometrial ablation performed?

Prior to the procedure, a woman needs to have an endometrial sampling (biopsy) performed to exclude the presence of cancer. Imaging studies and/or direct visualization with a hysteroscope (a lighted viewing instrument that is inserted to visualize the inside of the uterus) are necessary to exclude the presence of uterine polyps or benign tumors (fibroids) beneath the lining tissues of the uterus. Polyps and fibroids are possible causes of heavy bleeding that can be simply removed without the need for ablation of the entire endometrium. Obviously, the possibility of pregnancy must be excluded, and intrauterine contraceptive devices (IUDs) must be removed prior to considering endometrial ablation.

Hormonal therapy may be given in the weeks prior to the procedure (particularly in younger women), in order to shrink the endometrium to an extent whereby ablation therapy has the greatest likelihood of success; because the thinner the endometrium, the greater the chances for successful ablation.

To begin the procedure, the cervical opening is dilated to allow passage of the instruments into the uterine cavity. Different procedures have been used and are all similarly effective for destroying the uterine lining tissue. These include laser beam, electricity, freezing, heating, or microwave energy.

The choice of procedure depends upon a number of factors, including

• the preference and experience of the surgeon,
  
  
• the presence of fibroids, the size and shape of the uterus,
  
  
• whether or not pretreatment medication is given, and
  
  
• the type of anesthesia desired by the patient.

The type of anesthesia required depends upon the method used, and some endometrial ablation procedures can be performed with minimal anesthesia during an office visit. Others may be performed in an outpatient surgery department.