Endometrial Ablation

Endometrial ablation is a minimally invasive surgical procedure designed to alleviate excessive menstrual bleeding, also known as menorrhagia, in women. According to the American College of Obstetricians and Gynecologists (ACOG), approximately 1 in 5 women in the United States suffer from heavy menstrual bleeding, affecting over 10 million women annually. Endometrial ablation offers a viable alternative to hysterectomy, relieving debilitating symptoms and improving quality of life. By destroying or removing the lining of the uterus (endometrium), this procedure reduces or eliminates menstrual bleeding, providing a solution for women seeking to manage their symptoms and regain control over their reproductive health.

To be well-informed about endometrial ablation, read this informative blog! 

What is Endometrial Ablation?

Endometrial ablation is a minimally invasive surgical procedure designed to treat excessive menstrual bleeding, or menorrhagia, by destroying or removing the lining of the uterus (endometrium). This destruction of the endometrium reduces or eliminates menstrual bleeding, alleviating symptoms associated with heavy periods, such as pelvic pain, fatigue, and emotional distress. 

Endometrial ablation is typically performed on an outpatient basis, offering a viable alternative to hysterectomy for women who no longer wish to become pregnant and are seeking relief from debilitating menstrual symptoms.

How is Endometrial Ablation Classified?

Endometrial ablation can be classified into several types based on the technique, energy source, and instrumentation. Here are some common classifications:

Types of Endometrial Ablation

• Thermal Ablation: Heat-based procedures using heated fluids or gasses.
• Cryoablation: Cold-based procedures using freezing temperatures.
• Radiofrequency Impedance-Controlled Ablation (NovaSure): Uses radiofrequency energy.
• Electrothermal Ablation (Thermachoice): Uses electrical heat.
• Hydrothermal Ablation (HTA): Uses heated water.
• Microwave Ablation: Uses microwave energy.
• Laser Ablation: Uses laser energy.

Generation of Endometrial Ablation

• First-Generation Ablation (1980s-1990s): Early techniques using laser, electrocautery, and cryoablation.
• Second-Generation Ablation (1990s-2000s): Introduced radiofrequency impedance-controlled ablation.
• Third-Generation Ablation (2000s-present): Advanced technologies with improved efficacy and safety.

Technique-Based Classification

• Hysteroscopic Ablation: Performed through the cervix using a hysteroscope.
• Non-Hysteroscopic Ablation: This does not require visualization of the uterus.

When is Endometrial Ablation Indicated?

Endometrial ablation is typically indicated for women experiencing:

Primary Indications

• Heavy Menstrual Bleeding (Menorrhagia): Excessive bleeding interfering with daily life.
• Prolonged Menstrual Bleeding: Bleeding lasting more than 7-10 days.
• Dysmenorrhea: Severe menstrual cramps.
• Menometrorrhagia: Irregular and heavy bleeding.

Secondary Indications

• Failed Medical Therapy: Ineffective or intolerable medical treatments.
• Failed Hormonal Therapy: Ineffective or intolerable hormonal treatments.
• Anemia: Iron deficiency anemia due to heavy bleeding.
• Pelvic Pain: Chronic pelvic pain associated with heavy bleeding.
• Fibroids: Symptomatic uterine fibroids with heavy bleeding.
• Polyps: Endometrial polyps with heavy bleeding.
• Adenomyosis: Heavy bleeding and pelvic pain.

When is Endometrial Ablation Contraindicated?

Endometrial ablation is contraindicated in the following situations:

Absolute Contraindications

• Pregnancy or suspected pregnancy
• Active pelvic infection (e.g., endometritis, PID)
• Cancer or suspected cancer of the uterus, cervix, or ovaries
• 4. Known or suspected endometrial hyperplasia
• 5. Uterine anomaly or previous uterine surgery (e.g., C-section, myomectomy)
• 6. IUD (intrauterine device) in place
• 7. Desire for future pregnancy
• 8. Undiagnosed abnormal uterine bleeding

Relative Contraindications

• Younger women (<40 years old) with heavy menstrual bleeding
• Women with ovary-sparing hysterectomy
• History of Pelvic Radiation Therapy
• Uterine fibroids > 3 cm in diameter
• Adenomyosis with significant uterine enlargement
• Previous endometrial ablation or uterine surgery
• Hormone-sensitive cancers (e.g., breast cancer)
• Immunocompromised patients (e.g., HIV, chemotherapy)

Medical Conditions

• Bleeding disorders (e.g., hemophilia)
• Severe cardiovascular disease
• Uncontrolled hypertension
• Diabetes mellitus with vascular complications
• Severe respiratory disease
• Liver or kidney disease
• Coagulopathy or anticoagulant therapy

What to Expect Before an Endometrial Ablation?

Here's what to expect before an endometrial ablation:

Pre-Procedure Preparation (1-4 Weeks Before)

• Medical history review and physical examination by your doctor 
• Ultrasound or MRI scan to evaluate the uterus 
• Endometrial biopsy to rule out cancer or hyperplasia
• Pap test
• Infectious disease screening (if necessary)
• Blood tests (e.g., complete blood count, blood type)
• Discontinue hormonal contraceptives or IUDs
• Stop taking aspirin, ibuprofen, or other blood thinners

Pre-Procedure Instructions (1-2 Days Before)

• Fast from midnight (no food or drink)
• Arrange for someone to drive you home
• Plan for 1-2 days of recovery
• Stop smoking and avoid secondhand smoke
• Avoid heavy lifting, bending, or strenuous activity

Day of Procedure

• Arrive at the hospital or clinic 1-2 hours before the scheduled time
• IV insertions for anesthesia or sedation
• Review and sign consent forms
• Discuss any concerns or questions with your healthcare provider

How is Endometrial Ablation Performed?

Here's an overview of different types of endometrial ablation procedures:

Thermal Balloon Ablation (Thermachoice)

• A heated balloon is inserted into the uterus through the cervix.
• The balloon is filled with fluid and heated to 194°F (90°C).
• The heat destroys the endometrium.
• - Procedure duration: 8-10 minutes.

Radiofrequency Impedance-Controlled Ablation (NovaSure)

• A mesh device is inserted into the uterus through the cervix.
• Radiofrequency energy is emitted, heating the endometrium.
• The procedure is controlled by impedance monitoring.
• Procedure duration: 90 seconds.

Cryoablation

• A cryoablation probe is inserted into the uterus through the cervix.
• Nitrous oxide or carbon dioxide gas freezes the endometrium.
• The frozen tissue eventually sheds.
• Procedure duration: 10-15 minutes.

Loop Electrosurgical Ablation

• A heated loop is inserted into the uterus through the cervix.
• The loop destroys the endometrium through electrocautery.
• Procedure duration: 10-30 minutes.

Microwave Ablation

• A microwave probe is inserted into the uterus through the cervix.
• Microwave energy heats and destroys the endometrium.
• Procedure duration: 3-5 minutes.

Hydrothermal Ablation (HTA)

• Heated fluid is circulated within the uterus.
• The heat destroys the endometrium.
• Procedure duration: 10-15 minutes.

Laser Ablation

• Cervical dilation
• Insertion of laser fiber through the cervix into the uterus to destroy the lining
• Procedure Duration: 20- 30 minutes 

What Happens After Endometrial Ablation During the Recovery Process?

During the recovery process after endometrial ablation, you may experience:

Immediate Recovery (0-24 hours)

• Cramping: Mild to moderate cramping, similar to menstrual cramps.
• Vaginal discharge: Clear or bloody discharge.
• Bleeding: Light to moderate bleeding.
• Dizziness or nausea: Due to anesthesia or procedure.
• Fatigue: Rest and avoid heavy activity.

Short-Term Recovery (1-2 weeks)

• Vaginal discharge: May persist for 1-2 weeks.
• Spotting or light bleeding: This may occur for 2-4 weeks.
• Cramping: Gradually subsides.
• Abdominal pain: Mild, temporary.
• Emotional changes: Mood swings, anxiety.

Physical Recovery

• Rest: Avoid heavy lifting, bending, or strenuous activity.
• Pain management: Follow medication instructions.
• Hygiene: Use sanitary pads or tampons for discharge or bleeding.
• Dietary changes: Follow a balanced diet and avoid heavy meals.
• Fluid intake: Stay hydrated.

Return to Normal Activities

• Work: 1-2 weeks, depending on job requirements.
• Exercise: Gradually resume strenuous activities.
• Sexual activity: Resume 1-2 weeks post-procedure.
• Travel: Avoid heavy travel for 2-4 weeks.

Are There Any Complications Involved in Endometrial Ablation?

Although endometrial ablation is a minimally invasive and safe procedure, you may experience certain complications, such as:

• Bleeding or hemorrhage
• Infection (fever, pelvic pain, or foul odor)
• Uterine perforation (rare but potentially life-threatening)
• Cervical injury
• Anesthesia complications
• Pelvic pain or cramping
• Vaginal discharge or bleeding
• Infection (continued or recurrent)
• Cervical stenosis (narrowing of the cervix)
• Urinary tract infection
• Recurrent bleeding or spotting
• Chronic pelvic pain
• Endometrial regeneration (ablation failure)
• Uterine scarring or adhesions

Other Potential Issues

• Hormonal changes or imbalance
• Emotional changes (anxiety, depression)
• Sexual dysfunction
• Infertility or pregnancy complications (if pregnancy occurs)

Rare but Serious Complications

• Uterine rupture
• Bowel or bladder injury
• Blood clots or thromboembolism
• Sepsis or organ failure
• Death (infrequent)

Final Note 

Endometrial ablation is a minimally invasive surgical procedure that offers a highly effective solution for women suffering from excessive menstrual bleeding, dysmenorrhea, and other uterine-related issues. With various techniques and technologies available, this procedure provides a tailored approach to address individual needs. With success rates exceeding 80%, endometrial ablation has revolutionized the management of menstrual disorders, improving the quality of life for countless women. As medical technology continues to evolve, endometrial ablation remains a valuable treatment option for women seeking relief from debilitating menstrual symptoms.