Endometrial Ablation

Many women experience prolonged or heavy menstrual bleeding at a given point in their lifetime. Others will bleed between periods, which may be uncomfortable. This is not normal as it may lead to complications like anemia due to extensive loss of blood. You need to see a doctor as soon as possible when you have a longer or heavier than usual menstrual cycle.

If you are in Los Angeles and have menstrual bleeding problems, visit the Gyn LA clinic for treatment. Typically, our doctors will prescribe an intrauterine device (IUD) or medication to help alleviate your problematic periods. If these methods don’t work, endometrial ablation will be another option. In this article, we will explore the endometrial ablation process and the factors to consider, which include complications, side effects, and recovery period. 

Overview of Endometrial Ablation

Endometrial ablation refers to a procedure conducted to get rid of the thin lining of the uterus (endometrium). It’s done to reduce or stop heavy menstrual flow. However, it’s only performed on women that don’t plan on conceiving in the days to come since, in certain women, menstruation might stop completely.

The procedure isn’t surgery. Therefore you won’t have any incision (cut). Instead, your doctor will insert a small piece of equipment through the vagina to the uterus. The doctor has many ways to conduct the procedure, and the tools vary based on what method is used to destroy the endometrium. The various methods the physician can use include:

  • Fluids (hydrothermal). Here, a heated fluid is used. The fluid gets pumped into your uterus to get rid of the lining.
  • Electricity (electrocautery or electrical). Under this process, your doctor utilizes an electric current, which travels via a rollerball or wire loop. This current is placed on your uterus lining to destroy it.
  • Radiofrequency ablation. Here, your doctor places an electrical mesh in your uterus and expands it. He/she then sends electrical current generated by radio waves, which destroy the endometrium.
  • Microwave ablation (microwave). In this process, your physician will send microwave energy via a fine probe that destroys the lining.
  • Cryoablation (cold). Your doctor utilizes a probe that has freezing temperatures to freeze your uterine lining.
  • Balloon therapy. Here, your doctor puts a catheter into your uterus. This catheter has a balloon attached at the end. The physician fills this balloon with fluid then heats it. This heated fluid then destroys the endometrium.

Other endometrial ablation procedures are conducted by the use of a tool known as a hysteroscope. The tool enables your doctor to see inside the uterus. He/she could attach a camera onto this tool so that it records what he/she sees.

We have some forms of endometrial ablations that can be conducted in your physician’s office while others have to take place in operating rooms. Factors like the condition and size of the uterus will assist in determining what endometrial ablation process is the most appropriate for you.

Reasons for Carrying Out Endometrial Ablation

You could decide to undergo an endometrial ablation procedure if you have long or heavy periods. You may also do it if you are bleeding in-between periods. In some cases, the menstrual bleeding can be too heavy in that it impacts your day-to-day activities and leads to anemia due to a lower blood count.

Heavy menstrual bleeding is defined as the kind of bleeding that needs you to change tampons or sanitary pads every hour. On the other hand, prolonged menstrual bleeding is defined as the bleeding that lasts more than seven days.

Problems associated with menstrual bleeding may be a result of hormone issues. This is true, especially for women that are approaching menopause or those that have undergone the menopause stage. Other reasons are abnormal tissues like polyps, fibroids, uterine cancer, or endometrial cancer.

An endometrial ablation process lessens menstrual flow or makes it stop completely. You might be incapable of getting pregnant after undergoing this procedure. The reason for this is that the endometrium wall, whereby the egg gets implanted after fertilization, has been extracted. Pregnancies that do occur after endometrial ablations aren’t healthy, so it’s critical to use reliable birth control methods. Nevertheless, your reproductive organs will remain intact. Note that your doctor may have additional reasons to recommend endometrial ablation.

Also, note that before recommending endometrial ablation, your doctor may generally begin by prescribing an IUD or medications to lower menstrual bleeding. The doctor may recommend the option of endometrial ablation if these other treatment methods aren’t helping or you are not capable of having other therapies.

Endometrial Ablation Risks

Complications after undergoing an endometrial ablation procedure are not common. They may include:

  • Infection
  • Bleeding
  • Pain
  • Fluid overloading into a patient’s bloodstream
  • Puncturing of the patient’s bowel or uterine wall
  • Cold or heat damage to neighboring organs

There might be other risks you may face depending on your health condition. Ensure you discuss with your physician any concerns you have before undergoing the process. You might not be capable of undergoing endometrial ablation should you have:

  • Cervical or vaginal infection
  • Uterine, endometrial, or cervical cancer
  • Pelvic inflammatory disease
  • Recent pregnancy
  • IUD (Intrauterine Device)
  • Weak muscles of the uterine wall
  • Vertical or classic C-section cut
  • Abnormal shape or structure of your uterus
  • Past uterine surgical procedure for fibroids

A few things may make it challenging to carry out particular endometrial ablation types. These include large or short lengths of the uterus and narrowing of the inside of the patient’s cervix.

How to Prepare for Endometrial Ablation

A few weeks before undergoing this procedure, your physician will explain how the procedure is conducted. Ask them any questions and discuss with them any concerns you have concerning the process. Also, before the process, your doctor:

  • Will ask you to stop drinking or eating for eight hours before undergoing the procedure. Usually, this means you will stop drinking and eating after midnight.
  • May give you medication that will help you to relax. Since the medicine might make you drowsy, you’ll have to have a person to take you home.
  • Might conduct a pregnancy test. As we mentioned before, endometrial ablation cannot be performed if you’re pregnant.
  • May remove an intrauterine device. Endometrial Ablation is not done with an intrauterine device in place.
  • Thin the endometrium. Certain endometrial ablation types are highly successful when a patient’s lining of the uterus is thin. The doctor could prescribe medicines or conduct a dilation & curettage, a process whereby the physician scrapes off extra tissue.
  • Might check for any cancer. A catheter will be inserted via the cervix to get a sample of the endometrium, which the doctor will test for cancer.
  • Discuss options for anesthesia. Some endometrial ablation methods require the patient to have general anesthesia, so they are asleep through the process. On the other hand, other types may be done with numbing shots into the uterus or cervix or with conscious sedation.

On your part as a patient, you have to:

  • Notify your doctor if you’re pregnant or feel you might be pregnant
  • Inform your physician if you’re allergic to or sensitive to any tape, medicines, anesthetic drugs (general and local), or latex
  • Tell your doctor about all the medications you’re taking, including over-the-counter and prescription medicines, or herbal supplements.
  • Inform your doctor if you’ve had any bleeding disorder. Additionally, tell him/her if you’re taking anticoagulants (blood-thinning medication), aspirin, or any other medication that affects blood clotting. You might be required to stop using these drugs before the process.
  • You might want to carry with you a sanitary towel for wearing home after undergoing the procedure.
  • Obey any additional instructions your physician gives you in preparation for the process.

What to Expect During the Procedure

As we mentioned before, you can undergo endometrial ablation procedure as an outpatient in your doctor’s office, or during admission in the hospital. The way this process is conducted may vary based on your health condition as well as your physician practices.

The kind of anesthesia to be administered depends on the process being performed. It can be done when you’re asleep after the administration of general anesthesia. Alternatively, it can also be done when you’re awake after the administration of epidural or spinal anesthesia. If epidural or spinal anesthesia is administered, you won’t feel anything from the waist down. Your anesthesiologist will monitor your blood pressure, heart rate, level of blood oxygen, and breathing during the process. Generally, endometrial ablation is done following these steps:

For endometrial ablation where a hysteroscope is used:

  1. An IV (intravenous) line might be placed in your hand or arm.
  2. You’ll lie on the operating table. Your legs and feet will be supported so you can undergo a pelvic examination.
  3. Your doctor may place a catheter in your bladder for urine drainage.
  4. The physician will place a speculum in the vagina. He/she uses this tool to widen the vagina and be able to see your cervix.
  5. The doctor will then clean the cervix using an antiseptic compound.
  6. The physician might use a special kind of forceps in holding the cervix firm for the process.
  7. The doctor then opens your cervix by placing thin bars in it. Each bar has a wider breadth compared to the preceding one. Doing this will enlarge your cervix opening gradually so your doctor can place the hysteroscope into it.
  8. The hysteroscope is put via the opening of the cervix and into your uterus.
  9. The doctor might use carbon dioxide or a liquid to fill your uterus. This helps them to see it more clearly.
  10. The physician will then place the ablation equipment via the hysteroscope.  Then, he/she moves a wire loop or rollerball that has electrical current across your endometrium. This current destroys it.
  11. If it’s hydrothermal ablation, the physician will place a hot liquid in the uterus via a catheter. He/she pumps the fluid around the uterus, which destroys the lining.
  12. Once this procedure is complete, the doctor pumps any fluid from the uterus, then removes the equipment.

For other forms of ablations:

Steps (i) to (v) above are followed. After that:

  1. The doctor then numbs the region using a tiny needle to inject the medicine.
  2. A thin, bar-like tool is then inserted via the opening of the cervix. This is done to determine the length of the cervical canal and uterus. This tool might cause mild cramping.  It is then removed afterward.
  3. For radiofrequency ablation, the doctor puts a unique mesh via the opening of the cervix.  He/she will then expand it so it can fill your uterus. Radio wave energy is then passed through the mesh. The energy destroys the uterine line. Suction assists in removing steam, liquids, or any other gas produced during the ablation process.  This could lead to mild to intense cramping.
  4. For balloon ablation, the doctor places a slight balloon via the opening of the cervix and into the uterus. He/she will then put a heated liquid in the balloon, which destroys the endometrium. A computer controls the temperature, pressure, and the time the treatment occurred. This might also cause mild to intense cramps.
  5. With cryoablation, the physician puts a unique probe via the opening of the cervix and into your uterus. He/she then places an ultrasound transducer on the abdomen that guides the probe to the correct regions in your uterus to freeze. This could lead to mild to intense cramps as well.
  6. When the process is concluded, your doctor removes the tools.

After the Process

The recovery process varies depending on the ablation type you underwent, as well as the anesthesia type used. You’ll be transferred to a recovery room if you have epidural, general, or spinal anesthesia. After your pulse breathing, and blood pressure have stabilized, and you’re alert, you’ll be sent home or transferred to the hospital room. If you were an outpatient, you would need someone else to take you back home. In case you didn’t get anesthesia, you’ll need a rest of about two hours before you can go home.

You might need to put on a sanitary towel due to bleeding. It’s normal to experience vaginal bleeding after the process for several days. Also, you may experience a watery-bloody discharge for a few weeks.

You might have nausea, intense cramping, the urge to urinate frequently, vaginal discharge, or vomiting for some days after the process. The cramping could continue for an extended period.

Don’t use tampons, douche, or have sexual intercourse for two to three days after this procedure, or as your physician will advise you. Also, you may have other restrictions on your activities, including avoiding heavy lifting or strenuous tasks. You may resume your usual diet except if your doctor says otherwise.

Take pain relievers for soreness or cramping as your doctor has recommended. Aspirin may elevate the chances of bleeding; therefore, it shouldn’t be taken. Ensure you take only the medicines that your health care provider recommends. Your doctor will inform you when you can go back for further care or treatment.

Notify the doctor if you notice any of the following:

  • Chills or fever
  • Foul-smelling vaginal discharge
  • Trouble urinating.
  • Severe pain in the abdomen
  • Heavy bleeding lasting more than two days after ablation
  • Depending on your condition, you may be given further instructions once the procedure is complete. Discuss with your doctor about the ideal birth control methods for you.

Find an Experienced Gynecologist Near Me

It’s undoubtedly uncomfortable to live with problematic periods since they limit daily activities. If you are one of the women experiencing this, see your gynecologist as soon as possible for treatment before things get complicated. Endometrial ablation is one of the treatment options to address this problem. For Los Angeles residents seeking to undergo this procedure, call the Gyn LA clinic at 310-375-8446 to schedule an appointment. We will first evaluate your case and advise whether or not you qualify for the process. Most importantly, our services are quick, efficient, and we will make you as comfortable as possible throughout the process. Call us today and take a step towards getting better.