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Endometrial ablation facts
- Endometrial ablation is the surgical destruction of the lining tissues of the uterus.
- Endometrial ablation is one type of treatment for abnormal uterine bleeding that is due to a benign (non-cancerous) condition.
- Endometrial ablation must not be performed if pregnancy is desired in the future.
- Laser beam, electricity, freezing, and heating are all successfully used methods for endometrial ablation. The choice of procedure depends upon a number of factors.
- Some women may experience regrowth of the endometrium and require further surgery.
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. It is not a sufficient treatment when bleeding is caused by cancer of the uterus, since cancer cells may have grown into the deeper tissues of the uterus and can't often 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. This treatment is not a first-line therapy for heavy bleeding and should only be considered only 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 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 where 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, and heating.
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.
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.
What is the outlook after endometrial ablation?
The majority of women who undergo endometrial ablation report a successful reduction in abnormal bleeding. Up to half of women will stop having periods after the procedure. Yet, studies indicate the rate of failure (defined as bleeding or pain after endometrial ablation that required hysterectomy or reablation) was 16% to 30% at 5 years. Failure was most likely to occur in women younger than 45 years and in women with 5 or more children, prior tubal ligation, and a history of painful menstrual cramps. After endometrial ablation, 11% to 36% of women had a repeat ablation or other uterine-sparing procedure.
Although the procedure removes the uterine lining and typically results in infertility, it should not be considered as a birth control measure, because pregnancy can still occur in a small portion of the endometrium which remains or has regrown. In this case there may be severe problems with the pregnancy, and the procedure should never be performed if the woman may desire pregnancy in the future.
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El-Nashar SA, Hopkins MR, Creedon DJ, et al. Prediction of treatment outcomes after global endometrial ablation. Obstet Gynecol. Jan 2009;113(1):97-106. [Medline].
Picket, SD, MD, et al. Endometrial Ablation. Medscape. Updated: Nov 20,2016.
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During endometrial biopsy, a piece of tissue is removed from the inner lining of the uterus that is painful. Endometrial biopsies are performed to determine the cause of abnormal uterine bleeding. Endometrial biopsy can cause moderate to severe pain. Medications can be given to reduce the pain. Risks include infection, bleeding, and perforation of the uterus.
A hysterectomy is a surgical procedure in which the uterus is removed. There are a variety of surgical techniques for performing hysterectomies, which include vaginal hysterectomy, total hysterectomy, laparoscopy-assisted vaginal hysterectomy (LAVH), supracervical hysterectomy, laparoscopic supracervical hysterectomy, radical hysterectomy, and oophorectomy and salpingo-oophorectomy hysterectomies.
Complications include infection, pain, and bleeding. The type of hysterectomy performed is dependent on the woman and the reason for the procedure.
Hysteroscopy is a minimally invasive surgical procedure performed to diagnose and treat women's conditions, for example, abnormal vaginal bleeding, congenital abnormalities of the female genital tract, scarring from previous procedures, and removal of uterine fibroids or tumors.
Hysteroscopy may be recommended for evaluating a number of gynecological problems, including scarring, or adhesions, from previous uterine surgery or instrumentation such as dilation and curettage (D&C).
InfertilityInfertility is the diminished ability to conceive a child. Infertility can be a problem with both men and women. Infertility in men can be caused by medical conditions, unhealthy habits, and toxins from the environment. Infertility in women can be caused by problems with ovarian function, the Fallopian tubes, or the physical characteristics of the uterus. Methods of conceiving for couples that cannot conceive include intrauterine inseminations (IUIs) or in vitro fertilization (IVF), specific drugs, assisted reproductive technology (ART), surgery, and gestational carrier.
MenopauseMenopause is the time in a woman's life when menstrual periods permanently stop, also called the "change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Menstrual cramps (pain in the belly and pelvic area) are experienced by women as a result of menses. Menstrual cramps are not the same as premenstrual syndrome (PMS). Menstrual cramps are common, and may be accompanied by headache, nausea, vomiting, constipation, or diarrhea. Severity of menstrual cramp pain varies from woman to woman. Treatment includes OTC or prescription pain relief medication.
Menstruation (menstrual cycle) is also referred to as a "period." When a woman menstruates, the lining of the uterus is shed. This shedding of the uterine linking is the menstrual blood flow. The average menstrual cycle is 28 days. There can be problems with a woman's period, including heavy bleeding, pain, or skipped periods. Causes of these problems may be amenorrhea (lack of a period), menstrual cramps (dysmenorrhea), or abnormal vaginal or uterine bleeding. There are a variety of situations in which a girl or woman should see a doctor about her menstrual cycle.
Nausea and Vomiting
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. There are numerous cases of nausea and vomiting. Some causes may not require medical treatment, for example, motion sickness, and other causes may require medical treatment by a doctor, for example, heart attack, lung infections, bronchitis, and pneumonia.
Some causes of nausea and vomiting may be life threatening, for example, heart attack, abdominal obstruction, and cancers.
Treatment of nausea and vomiting depends upon the cause.
Pulmonary edema (swelling or fluid in the lungs) can either be caused by cardiogenic causes (congestive heart failure, heart attacks, abnormal heart valves) or noncardiogenic causes such as:
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The treatment of pulmonary edema depends on the cause of the condition.
Uterine CancerThough uterine cancer's cause is unknown, there are many factors that will put a woman at risk, including being over age 50, having endometrial hyperplasia, using hormone replacement therapy, obesity, using tamoxifen, being Caucasian, and/or having colorectal cancer. Symptoms of cancer of the uterus (endometrial cancer) include abnormal vaginal bleeding, painful urination, painful intercourse, and pelvic pain. Treatment depends on staging and may include radiation therapy or hormone therapy.
Uterine fibroids are benign (non-cancerous) tumors in the womb (uterus). Most uterine fibroids do not cause symptoms; however, if the fibroid is large enough and in the right location, it may cause symptoms of pelvic pain, abnormal vaginal bleeding, and pressure on the bladder or rectum.
Uterine fibroids that remain small and do not grow usually do not need treatment; however, surgery to remove the fibroid may be necessary. Uterine fibroids do not cause cancer; however, there is a rare, fast-growing cancerous called leiomyosarcoma.
Uterine Fibroids PictureUterine fibroids are benign tumors of the uterus (the womb) and the single most common indication for hysterectomy. See a picture of Uterine Fibroids and learn more about the health topic.
Benign uterine growths are tissue enlargements of the female womb (uterus). Three types of benign uterine growths are uterine fibroids, adenomyosis, and uterine polyps. Symptoms include:
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- Pelvic pain
- Pain during intercourse
- Pain during bowel movements
Diagnosis and treatment of benign uterine growths depends upon the type of growth.
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding.
Causes of abnormal may arise from a variety of conditions that may include, uterine fibroids, IUDs, hypothyroidism, hyperthyroidism, lupus, STDs, pelvic inflammatory disease, emotional stress, anorexia nervosa, polycystic ovary syndrome (PCOS), cancers, early pregnancy.
The treatment for abnormal or irregular vaginal bleeding depends upon the cause.
Vaginitis refers to inflammation of the vagina. Vaginitis can be caused by infections, menopause, or poor hygiene. Symptoms of vaginitis include vaginal itching, discharge, odor, pain, or discomfort. Treatment for vaginitis depends on the cause. Antibiotics may be necessary for some forms of vaginitis.