Endometrial Ablation (Uterine Lining Removal)

What is endometrial ablation?

Endometrial ablation is a procedure to permanently remove a thin tissue layer of the lining of the uterus to stop or reduce excessive or abnormal bleeding in women for whom childbearing is complete.

Endometrial ablation may be recommended to destroy the lining of the uterus. Because the endometrial lining is destroyed, it can no longer function normally, and bleeding is stopped or controlled. In most cases, a woman cannot become pregnant after endometrial ablation because the lining that nourishes a fetus has been removed. However, after ablation, a woman still has her reproductive organs. In some cases, endometrial ablation may be an alternative to hysterectomy.

There are several techniques used to perform endometrial ablation including the following:

• Electrical or electrocautery: Electric current travels through a wire loop or rollerball that is applied to the endometrial lining to cauterize the tissue
• Hydrothermal: Heated fluid is pumped into the uterus and destroys the endometrial lining with high temperature
• Balloon therapy: A balloon at the end of a catheter is inserted into the uterus and filled with fluid, which is then heated to the point that the endometrial tissues are eroded away
• Radiofrequency ablation: A triangular mesh electrode is expanded to fill the uterine cavity. The electrode delivers electrical current and destroys the endometrial lining.
• Cryoablation (freezing): A probe uses extremely low temperatures to freeze and destroy the endometrial tissues
• Microwave ablation: Microwave energy is delivered through a slender probe that has been inserted into the uterus and destroys the endometrial lining.

Some endometrial ablation procedures are performed using a hysteroscope, a lighted viewing device inserted through the vagina for a visual examination of the canal of the cervix and the interior of the uterus. Ablation instruments can be inserted through the opening and a camera or video camera can be used to record findings through the hysteroscope.

A resectoscope may be used instead of the hysteroscope. This device is similar to the hysteroscope but has a built-in wire that uses electrical current for resecting (removing) endometrial tissue.

Other ablation techniques use ultrasound to guide the instrument to the areas for treatment. Ultrasound is a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs.

What can I expect from the procedure?

An endometrial ablation may be performed in a physician’s office, on an outpatient basis, or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices. The type of anesthesia will depend upon the specific procedure being performed.

Generally, ablations using a hysteroscope or resectoscope follow this procedure:

1. You will be asked to undress completely and put on a hospital gown.
2. An intravenous (IV) line may be started in your arm or hand.
3. You will be positioned on an operating or examination table, with your feet and legs supported as for a pelvic examination.
4. A urinary catheter may be inserted.
5. Your physician will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
6. Your cervix may be cleansed with an antiseptic solution.
7. A type of forceps, called a tenaculum, may be used to hold the cervix steady for the procedure.
8. The cervix will be dilated by inserting a series of thin rods. Each rod will be larger in diameter than the previous one. This process will gradually enlarge the opening of the cervix so that the hysteroscope or resectoscope can be inserted.
9. The hysteroscope or resectoscope will be inserted through the cervical opening into the uterus.
10. A liquid solution or carbon dioxide gas may be used to fill the uterus for better viewing.
11. The ablation instrument will be inserted through the hollow opening of the hysteroscope. A rollerball or wire loop with electrical current will be passed across the endometrial tissues, destroying the tissues.
12. For hydrothermal ablation, a heated liquid is placed into the uterus through a catheter and circulated with a computer-controlled pump until the endometrial tissues are destroyed by the high temperatures.
13. After the procedure has been completed, any fluid will be pumped out from your uterus and the instruments will be removed.

Generally, other types of ablation techniques follow this procedure:

1. You will be asked to undress completely and put on a hospital gown.
2. An intravenous (IV) line may be started in your arm or hand.
3. You will be positioned on an examination table, with your feet and legs supported as for a pelvic examination.
4. Your physician will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
5. Your cervix may be cleansed with an antiseptic solution.
6. The physician will numb the area using a small needle to inject medication.
7. A thin, rod-like instrument, called a uterine sound, may be inserted through the cervical opening to determine the length of the uterus and cervical canal. This may cause some cramping. The sound will then be removed.
8. With balloon ablation, a silicone balloon will be inserted through the cervical opening into the uterine cavity and will be connected by a catheter to a computer console. Hot liquid will be circulated inside the balloon to destroy the endometrial tissues. The pressure, temperature, and time of the treatment will be controlled by the computer. This may cause some mild to strong cramping.
9. With radiofrequency ablation, a triangular mesh electrode will be inserted through the cervical opening and expanded to fill the uterine cavity. Radio-frequency energy will be passed into the mesh to destroy the tissues it contacts. Suction helps remove liquids, steam, and other gases that will be produced during ablation. This may cause some mild to strong cramping.
10. For cryoablation, a special probe that produces very cold temperatures will be inserted through the cervical opening into the uterus. An ultrasound transducer will be placed on your abdomen to guide the cryoablation probe to the appropriate areas in the uterus for freezing. This may cause some mild to strong cramping.
11. The instruments will be removed.

Are there any risks?

As with any surgical procedure, complications may occur. Some possible complications of endometrial ablation may include, but are not limited to, the following:

• Bleeding
• Infection
• Perforation of the uterine wall or bowel
• Overloading of fluid into the bloodstream

Patients who are allergic to or sensitive to medications, iodine, or latex should notify their physician.

If you are pregnant or suspect that you may be pregnant, you should notify your physician. Endometrial ablation during pregnancy may lead to miscarriage.

After the procedure

The recovery process will vary depending upon the type of ablation performed and the type of anesthesia that was administered. You may want to wear a sanitary pad for bleeding. It is normal to have vaginal bleeding for a few days after the procedure. You may also have a watery-bloody discharge for several weeks.

You may experience strong cramping, nausea, vomiting, and/or the need to urinate frequently for the first few days after the procedure. Cramping may continue for a longer time.

You may be instructed not to douche, use tampons, or have intercourse for two to three days after an endometrial ablation, or for the period of time recommended by your physician.

You may also have other restrictions on your activity, including no strenuous activity or heavy lifting.

Take a pain reliever for cramping or soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

• Notify your physician if you have any of the following:
• Foul-smelling drainage from your vagina
• Fever and/or chills
• Severe abdominal pain
• Excessive bleeding, or heavy bleeding longer than two days after the procedure
• Difficulty urinating