Endometrial ablation: A popular solution to abnormal bleeding for select patients
March 14, 2019
Some women experience abnormal bleeding, such as spotting throughout an entire month, heavy flow during periods, or irregular intervals between periods. Treatment for this inconvenient-to-unbearable condition typically starts with hormonal medication, and there are a variety of therapeutic options. For many women, endometrial ablation is a good option because it is minimally invasive and avoids chronic medication use.
Endometrial ablation can reduce abnormal bleeding or stop bleeding completely by destroying the lining of the uterus, or the endometrium, through high levels of heat. The endometrium contains special cells that serve a growing pregnancy, so it might try to grow back anew with each cycle. But endometrial ablation aims to ensure it doesn’t.
Who is a candidate for endometrial ablation?
To determine candidacy, we try to ascertain the cause of abnormal bleeding through diagnostic work-up. The procedure is best for pre- or perimenopausal women who suffer from heavy periods. The ideal candidate is a woman with bothersome heavy menses who no longer desires fertility, doesn’t have a congenital uterine anomaly (that is, born with an abnormally shaped uterus), and isn’t at risk for endometrial cancer.
For an appointment with one of our gynecologists, call 214-645-3888 to discuss treatments.
Prior to an ablation procedure, your doctor should sample the endometrium to ensure that there is no existing endometrial hyperplasia or cancer. Sampling of the uterus usually takes place in the office with an endometrial biopsy. Once the lining of the uterus is destroyed via the procedure, scarring can occur inside the uterus. This makes it difficult to sample the endometrium and determine whether women have endometrial cancer, so if you have a family history or have had endometrial hyperplasia (which can be a precursor to endometrial cancer), we won’t recommend endometrial ablation. Meanwhile, women who have had multiple cesarean sections (C-sections) or large myomectomies can have a thinner-than-usual uterus, which might increase risks of surgery.
Many women are at their wits’ end when they decide to have endometrial ablation. In fact, I’ve seen adult women who have experienced abnormal bleeding since they were 14! I tell women who have exhausted nonsurgical treatments and are done having children that if bleeding interferes with their everyday life – preventing them from doing certain activities, being intimate, or wearing the clothes they want – they might want to consider endometrial ablation.
"Many women are at their wits’ end when they decide to have endometrial ablation. In fact, I’ve seen adult women who have experienced abnormal bleeding since they were 14! I tell women who have exhausted nonsurgical treatments and are done having children that if bleeding interferes with their everyday life – preventing them from doing certain activities, being intimate, or wearing the clothes they want – they might want to consider endometrial ablation."
What are the risks of the procedure?
Major complications are rare, but because the procedure uses heat to destroy the lining of the uterus, the uterus can be thinned and surrounding organs such as the bladder, bowel, and vagina are put at a very low risk of complications from the heat.
A benefit of endometrial ablation is that the treatment can last until menopause and allow women to avoid the need for daily medication. However, about 20 percent of women require some kind of treatment afterward, such as a repeat ablation or a hysterectomy – so the surgery isn’t perfect. The reason for these additional treatments typically is that uterine tissue was not completely destroyed during surgery.
I see some women in their 20s who tell me they don’t want babies and they hate their periods and want them to go away. I understand that – however, this isn’t always a good option for women so young because their bodies will still experience a hormonal response for 20 years or longer before menopause. With functioning ovaries, their body will try to create new life during each ovulation cycle. This process can cause tiny areas of uterine lining tissue to try to grow back. The longer a woman is exposed to that, the higher the risk that her uterine lining will grow back. In general, women who are younger than 45 years old at the time of ablation are more likely to need an additional treatment such as hysterectomy in the future.
Managing health after endometrial ablation
After endometrial ablation, women should be on reliable birth control, such as an intrauterine device (IUD) or tubal ligation. Pregnancy after endometrial ablation can result in significant maternal or fetal risk. One might think burning off the endometrium would prevent pregnancy – if a small patch of endometrial tissue is left (which can happen, albeit rarely), a fertilized egg could implant there, resulting in pregnancy.
Abnormal bleeding can affect women’s everyday lives. If medications such as birth control pills or progesterone IUDs aren’t appropriate for you, speak with your doctor about whether you might be a candidate for endometrial ablation.