We perform endometrial ablation for the treatment of abnormal uterine bleeding. The procedure includes the surgical destruction of the tissues that line the uterus, known as the endometrium.
The abnormal bleeding is sometimes the result of a non-cancerous condition, but this procedure is not a sufficient treatment option when bleeding is caused by uterine cancer. This is because the cancerous cells might be in the deepest tissues of the uterus and therefore can’t be taken out using this procedure.
Endometrial ablation is only performed on women who are currently not pregnant and don’t have a desire to become pregnant in the future. It is also not performed if the patient is dealing with an active infection of the genital tract. Endometrial ablation is not the first line of action for the treatment of heavy bleeding and should only be considered when other therapies have not gotten the bleeding under control.
Prior to the procedure, your Ob-Gyn will perform an endometrial biopsy to rule out the possibility of the existence of cancer. Imaging studies and/or direct visualization with 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.
For younger women in particular, hormonal therapy may be recommended in the weeks leading up to the procedure to shrink the endometrium to an extent where ablation therapy has the greatest chance to succeed. The feeling is that the thinner the endometrium is, the greater the chance for effective ablation becomes.
The type of anesthesia utilized during endometrial ablation depends upon which method is performed. Some procedures can be performed with minimal anesthesia during an office visit while others are done as an outpatient procedure.
We don’t typically recommend this course of action as a first line solution for several reasons. We always try to suggest the most minimally invasive procedures and recommend medical management whenever possible. We also generally obtain a good outcome with medical management of our patients who have heavy bleeding.
Although endometrial ablation does work well for some women, the long-term results for addressing heavy bleeding with endometrial ablation are not always predictable. Another issue is that there is a risk that endometrial ablation might cover up endometrial cancer later in life, because it removes any endometrial spotting that would signal to you that something abnormal is happening in your body.
It’s a good idea to keep in mind that there are women who do become pregnant after they’ve had this procedure, so it’s very important that birth control or sterilization is discussed, as post-surgery pregnancies can be risky. Some insurance companies require that a woman be sterilized