Endometrial ablation is a procedure that removes the glands in the lining of the uterus, which are usually shed each month as a period. The procedure is performed to make periods lighter. Endometrial ablation is successful approximately 75% of the time. Having endometrial ablation does NOT mean you can’t get pregnant. Contraception is still required until menopause is documented. If you do get pregnant after an endometrial ablation, there is a higher risk of miscarriage, preterm delivery, and problems with the placenta. The procedure has There are both benefits and risks.
Benefits:
- Shorter, lighter periods, or possibly no periods.
- Cramps during periods often improve, but not in everyone.
- If someone has anemia (low red blood cell count) due to heavy bleeding during their periods, this usually resolves.
Risks:
With any procedure, there is a risk of bleeding, infection, problems with anesthesia, or injury to surrounding structures. Uterine perforation (when an instrument goes through the uterine wall) can sometimes occur. If this happens, endometrial ablation cannot be performed, and rarely additional surgery will be necessary if there is a concern over injury to bladder, bowel, or blood vessels. The risk of any of the above complications is approximately 1%.
Occasionally, abnormal bleeding or pelvic pain can occur after endometrial ablation. This can occur several months to many years after the procedure. This happens 10% of the time, and may require additional evaluation and treatment.
Sometimes after endometrial ablation, the cavity of the uterus can form scar tissue. This happens approximately 30% of the time. Scar tissue can make it difficult to evaluate any abnormal bleeding that may occur, before or after menopause. Abnormal bleeding is often evaluated with an endometrial biopsy (when a catheter is put through the cervix and a brush is placed in the uterus to collect cells), which is performed in the office or by hysteroscopy (which is when we place a camera in the uterine cavity). For the women who have scarring in their uterine cavity after endometrial ablation, often an endometrial biopsy or hysteroscopy are not possible. In these cases, a hysterectomy may be recommended.
Anyone who has had an endometrial ablation should alert their physician if they have pelvic pain or abnormal bleeding.
For women who have previously had their tubes tied, there is an 8% chance of pain occurring after having an endometrial ablation. This is called “post ablation tubal ligation pain syndrome”. It can occur months to years after the ablation. Usually, the treatment is laparoscopic (surgical) removal of the uterus (hysterectomy) and tubes. If this is required, the ovaries are left in place, so the patient does not undergo instant menopause.
Conclusion:
Most women who undergo endometrial ablation are extremely happy that they chose ablation. However, you need to understand that ablation does not improve heavy bleeding in all patients, and there are risks involved during the procedure, and possible long-term complications.
