Endometrial Ablation Guide to Purpose, Risks, and Recovery

Medically Reviewed By Sanaz Ghazal, MD, FACOG
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Endometrial ablation is the removal of the endometrium, or lining of the uterus. It is a minimally invasive procedure that treats heavy menstrual bleeding. It destroys the tissue that causes bleeding. This results in no further bleeding or lighter bleeding. This article explains the purpose of endometrial ablations, along with the expected recovery and possible side effects.

What is endometrial ablation?

Woman consulting with a doctor
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Endometrial ablation destroys the uterine lining. The uterus is an organ in the pelvis where a fetus grows during pregnancy. When pregnancy does not occur, the uterine lining sheds each month through menstrual bleeding.  Endometrial ablation is a treatment for abnormal menstrual bleeding.

Endometrial ablation has risks and potential complications. You may have other treatment options. Consider getting a second opinion before having an endometrial ablation.

Types of endometrial ablation

The most common types of endometrial ablation procedures include the following.

  • Balloon thermal ablation involves inserting a balloon into the uterus and filling it with heated liquid. The balloon expands and the heat destroys the uterine lining.
  • Cryoablation or freezing uses a small probe with a tip that cools to extremely low temperatures. Inside the uterus, it freezes the uterine lining to destroy it.
  • Electrosurgery involves inserting a special tool that carries an electrical current into the uterus. The current destroys the uterine lining. The tool can have a wire loop or other instrument on the tip. 
  • Hydrothermal ablation instills and circulates heated fluid, usually saline, inside the uterus. The heat destroys the uterine lining after 10 minutes.
  • Microwave ablation involves a probe that uses microwave energy to destroy the uterine lining.
  • Radiofrequency involves a probe that uses radio wave energy to destroy the uterine lining.

Who gets endometrial ablation, and when do doctors recommend it?

A doctor may recommend endometrial ablation to treat symptoms of atypical menstrual bleeding, including: 

  • bleeding or spotting between periods
  • bleeding that requires changing a pad or tampon every hour
  • cycles shorter than 21 days 
  • periods lasting more than 7 days

Doctors may only consider endometrial ablation if other treatment options have not worked. This includes medications such as:

  • gonadotropin-releasing hormone agonists
  • hormonal birth control
  • hormone therapy for perimenopause
  • nonsteroidal anti-inflammatory drugs
  • tranexamic acid (Lysteda)

Endometrial ablation is an alternative to a hysterectomy, which is the surgical removal of the uterus. 

Who should not have endometrial ablation?

Some people should not have an endometrial ablation. This includes anyone with the following conditions.

  • current or recent infection of the uterus
  • desire to bear a child in the future
  • disorders of the uterus or endometrium
  • postmenopausal status
  • recent pregnancy
  • uterine cancer

Who performs endometrial ablation?

An obstetrician-gynecologist (OB-GYN) performs endometrial ablation. An OB-GYN is a doctor who specializes in the medical and surgical treatment of the female reproductive system.

How is endometrial ablation performed?

Endometrial ablation is usually an outpatient procedure. It takes place in a hospital, outpatient surgery center, or office setting. 

You will need an endometrial biopsy a few weeks before having an endometrial ablation. This is necessary to rule out cancer. If you have an intrauterine device, your doctor will need to remove it.

Doctors also need to check the size and shape of the uterus beforehand. There are two options for this.

  • Hysteroscopy: This procedure involves inserting a lighted device through the cervix to view the inside of the uterus.
  • Ultrasonography: This noninvasive imaging exam use sound waves to produce images.

You will return for the ablation once this preparation is complete. You will take a pregnancy test to confirm that you are not pregnant.

The ablation itself is a short procedure. Once you have anesthesia, the doctor will dilate your cervix to open it for the procedure. You may need to take medications the night before to aid this. Then, using one of the types of probes from the discussion above, the doctor will perform the ablation.

Types of anesthesia that may be used

Doctors perform endometrial ablation using local or general anesthesia.

  • General anesthesia requires a combination of IV medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain
  • Local anesthesia involves injecting an anesthetic medication around certain nerves so you do not feel anything in the area. You will have sedation to keep you relaxed and comfortable.

What to expect on the day of your endometrial ablation

On the day of the ablation, you can generally expect to undertake the following steps.

  • Change into a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. 
  • Talk with a preoperative nurse who can answer questions and will start an IV line. 
  • Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
  • Talk with the doctor to verify the type of procedure you are having.

What are the risks and potential complications?

As with all procedures, endometrial ablation involves risks and possible complications. Complications may become serious in some cases. Complications can develop during the procedure or recovery.  

General risks of surgery 

The general risks of surgery include: 

  • anesthesia reaction
  • bleeding
  • blood clot, in particular, a deep vein thrombosis that develops in the leg or pelvis
  • infection
  • pain

Potential complications of endometrial  ablation

Complications of endometrial ablation include:

  • burns to the vagina, vulva, cervix, or bowel
  • damage to the bladder, bowels, or blood vessels
  • electrolyte imbalance from the fluid used in electrosurgery, though this is rare
  • missed or delayed uterine cancer diagnosis due to scarring and difficulty evaluating the endometrium afterwards
  • perforation or puncture of the uterus or bowels
  • residual obstructed endometrium, which occurs when part of the lining remains and causes cyclic pain, requiring hysterectomy
  • return of heavy bleeding, which may require a hysterectomy 

Reducing your risk of complications

You can help reduce the risk of certain complications by:

  • following the recommended activity, sex, and tampon use restrictions during recovery
  • notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
  • taking your medications exactly as a doctor has directed 
  • telling your care team if you have any allergies

What should I expect after endometrial ablation?

Knowing what to expect can help make recovery after endometrial ablation as smooth as possible. 

How long will it take to recover?

In most cases, endometrial ablation is an outpatient procedure. You will go home on the same day if you are recovering well. 

For the first 2–3 days, it is common to have a watery, bloody discharge that can be heavy. It should become thin and may last for a few weeks. Most patients return to their usual activities within a couple of days. It can take a few months to fully recover and see the complete results.

Will I feel pain?

You may have discomfort in the form of cramping for 1–2 days after the ablation. You may also have nausea and frequent urination that can last for 24 hours. Call your doctor if the discomfort gets worse or changes. It may be a sign of a complication. 

When should I call my doctor?

Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have signs of potential complications:

  • abdominal bloating, swelling, or pain 
  • fever, which is common after surgery, so your doctor will give instructions about when to call for a fever
  • heavy or unexpected vaginal bleeding
  • inability to urinate, pass gas, or have a bowel movement
  • increase in pain
  • vomiting

How might endometrial ablation affect my everyday life?

Endometrial ablation may relieve or reduce heavy bleeding so you can lead an active, normal life. It can also have effects on your everyday life, such as:

  • the continued need for birth control because while pregnancy after endometrial ablation is not likely and may be risky, it is possible
  • the continued need for routine screenings including Pap smears and pelvic exams because you still have a uterus and cervix
  • possible need for hysterectomy within 5 years due to failure of the ablation, which occurs in up to 16% of cases

Summary

Endometrial ablation removes the lining of the uterus. This slows or stops menstrual bleeding. Doctors may recommend it to relieve heavy or abnormal bleeding.

There are several medical alternatives to endometrial ablation to potentially consider. For example, hysterectomy is also an alternative and may be necessary if complications develop.

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Medical Reviewer: Sanaz Ghazal, MD, FACOG
Last Review Date: 2022 Jun 29
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