Endometrial Ablation (cont.)

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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 ablation of the entire endometrium. Obviously, the possibility of pregnancy must be excluded, and intrauterine contraceptive devices (IUDs) must be removed prior to 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 for success. The belief is 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 surgeon's preference and experience,
  • the presence of fibroids, the size and shape of the uterus,
  • whether or not pretreatment medication is given, and
  • 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 center.

What are the risks and complications of endometrial ablation?

Complications of the procedure are not common but may include:

  • accidental perforation of the uterus,
  • tears or damage to the cervical opening (the opening to the uterus), and
  • infection, bleeding, and burn injuries to the uterus or intestines.

In rare cases, fluid used to expand the uterus during the procedure can be absorbed into the bloodstream, leading to fluid in the lungs (pulmonary edema).

Some women may experience regrowth of the endometrium and need further surgery (see below).

Minor side effects from the procedure can occur for a few days, include cramping (like menstrual cramps), nausea, and frequent urination that may last for 24 hours. A watery discharge mixed with blood may be present for a few weeks after the procedure and can be heavy for the first few days.

Medically Reviewed by a Doctor on 2/21/2014

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