Endometrial ablation

Endometrial ablation is a medical procedure that is used to remove (ablate) or destroy the endometrial lining of a woman's uterus. This technique is most often employed for women who suffer from excessive or prolonged bleeding during their menstrual cycle but can not or do not wish to undergo a hysterectomy. The procedure is most commonly done on an outpatient basis. Uterine ablation is contraindicated in patients who may want to get pregnant.

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Procedure

A number of competing procedures are available. With the Novasure system a mesh is introduced into the cavity and the lining is destroyed by applying electrical energy to the mesh that will thermally damage the adjacent endometrium.

An alternative is the introduction of a balloon that is filled with heated fluid to destroy the uterine lining. Older methods utilize hysteroscopy to insert instruments into the uterus to destroy the lining under vision using laser or electrical current in a small loop. Another system introduces a radiofrequency rod that emits energy to destroy the uterine lining.

The HTA System is another alternative where a small telescope-like device called a hysteroscope is inserted into the uterus through the cervix, to help doctors see the area they are treating. Heated saline is then circulated to destroy the lining of the uterus.

The procedure is done while the patient is either under local anethesia, or, if necessary, general or spinal anesthesia. The recovery period can be from one day up to 2 weeks.

After the procedure, the endometrial heals by scarring, reducing or removing the possibility of future uterine bleeding. The patient will develop amenorrhea, however hormonal functioning will remain unaffected. It is still possible to become pregnant after having this procedure. Some type of birth control method must be used after having endometrial ablation.

Effectiveness

Approximately 90% of women who undergo this procedure will have reduced menstrual bleeding. Of those, approximately 45% will stop having period altogether. However, a second procedure or a hysterectomy will be required in approximately 22% of cases.

Risks

Although uncommon, the procedure can have serious complications including:

• Perforation of the uterus
• Burns to the uterus (beyond the endometrial lining)
• Pulmonary edema or embolism

See also

Asherman syndrome

Sources

• Palo Alto Medical Association
• Speroff L, Fritz MA. (2005). Dysfunctional uterine bleeding. In L Speroff, MA Fritz, eds., Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 548–571. Philadelphia: Lippincott Williams and Wilkins.