Endometrial Ablation

What is Endometrial Ablation

Endometrial ablation is a procedure that destroys the thin inner layer of the lining of the uterus (endometrium). This procedure may be done:

• To stop heavy periods.
• To stop bleeding that is causing anemia.
• To control irregular bleeding.
• To treat bleeding caused by small tumors (fibroids) in the endometrium.

This procedure is often an alternative to major surgery, such as removal of the uterus and cervix (hysterectomy). As a result of this procedure:

• You may not be able to have children. However, if you are premenopausal (you have not gone through menopause):
  • You may still have a small chance of getting pregnant.
  • You will need to use a reliable method of birth control after the procedure to prevent pregnancy.
• You may stop having a menstrual period, or you may have only a small amount of bleeding during your period. Menstruation may return several years after the procedure.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with the use of anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• A hole (perforation) in the uterus or bowel.
• Infection of the uterus, bladder, or vagina.
• Bleeding.
• Damage to other structures or organs.
• An air bubble in the lung (air embolus).
• Problems with pregnancy after the procedure.
• Failure of the procedure.
• Decreased ability to diagnose cancer in the endometrium.

What happens before the procedure?

• You will have tests of your endometrium to make sure there are no pre-cancerous cells or cancer cells present.
• You may have an ultrasound of the uterus.
• You may be given medicines to thin the endometrium.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you take diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your doctor tells you not to.
• Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

• You will lie on an exam table with your feet and legs supported as in a pelvic exam.
• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands and put on germ-free (sterile) gloves.
  • Your genital area will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given a medicine to help you relax (sedative).
• A surgical instrument with a light and camera (resectoscope) will be inserted into your vagina and moved into your uterus. This allows your surgeon to see inside your uterus.
• Endometrial tissue will be removed using one of the following methods:
  • Radiofrequency. This method uses a radiofrequency-alternating electric current to remove the endometrium.
  • Cryotherapy. This method uses extreme cold to freeze the endometrium.
  • Heated-free liquid. This method uses a heated saltwater (saline) solution to remove the endometrium.
  • Microwave. This method uses high-energy microwaves to heat up the endometrium and remove it.
  • Thermal balloon. This method involves inserting a catheter with a balloon tip into the uterus. The balloon tip is filled with heated fluid to remove the endometrium.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• As tissue healing occurs, you may notice vaginal bleeding for 4–6 weeks after the procedure. You may also experience:
  • Cramps.
  • Thin, watery vaginal discharge that is light pink or brown in color.
  • A need to urinate more frequently than usual.
  • Nausea.
• Do notdrive for 24 hours if you were given a sedative.
• Do not have sex or insert anything into your vagina until your health care provider approves.

Summary

• Endometrial ablation is done to treat the many causes of heavy menstrual bleeding.
• The procedure may be done only after medications have been tried to control the bleeding.
• Plan to have someone take you home from the hospital or clinic.

Endometrial Ablation, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• A need to urinate more frequently than usual for the first 24 hours.
• Cramps similar to menstrual cramps. These may last for 1–2 days.
• Thin, watery vaginal discharge that is light pink or brown in color. This may last a few weeks. Discharge will be heavy for the first few days after your procedure. You may need to wear a sanitary pad.
• Nausea.
• Vaginal bleeding for 4–6 weeks after the procedure, as tissue healing occurs.

Follow these instructions at home:

Activity

• Do notdrive for 24 hours if you were given amedicine to help you relax (sedative) during your procedure.
• Do nothave sex or put anything into your vagina until your health care provider approves.
• Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not take baths, swim, or use a hot tub until your health care provider approves. You will be able to take showers.
• Check your vaginal area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • More discharge or blood, instead of less.
  • Bad-smelling discharge.
• Keep all follow-up visits as told by your health care provider. This is important.

Drink enough fluid to keep your urine pale yellow.

Contact a health care provider if you have:

• Vaginal redness, swelling, or pain.
• Vaginal discharge or bleeding that gets worse instead of getting better.
• Bad-smelling vaginal discharge.
• A fever or chills.
• Trouble urinating.

Get help right away if you have:

• Heavy vaginal bleeding.
• Severe cramps.

Summary

• After endometrial ablation, it is normal to have thin, watery vaginal discharge that is light pink or brown in color. This may last a few weeks and may be heavier right after the procedure.
• Vaginal bleeding is also normal after the procedure and should get better with time.
• Check your vaginal area every day for signs of infection, such as bad-smelling discharge.
• Keep all follow-up visits as told by your health care provider. This is important.