The normal female reproductive system has two ovaries, two fallopian tubes and a uterus (womb).
- The ovaries are where human eggs are made.
- The fallopian tubes provide a pathway for the eggs to travel from the ovaries to the uterus.
- The uterus is the organ that nourishes and protects a growing baby during pregnancy.
- The cervix is the opening of the uterus into the vagina.
The endometrium is the tissue that lines the uterus. It is shed from the female body every month during menstruation.
- Abnormal uterine bleeding (AUB) is any vaginal bleeding that is different from a normal menstrual pattern. This includes bleeding or spotting after menopause.
- The most common type of AUB is menorrhagia. Menorrhagia is heavy or prolonged bleeding at normal monthly intervals.
- AUB can occur at any age. However, it is most common when menses starts or when a woman is approaching menopause.
An endometrial ablation is a surgical procedure that destroys the endometrium. The procedure can eliminate or cause a marked reduction of vaginal bleeding (menstrual flow). Endometrial ablation is performed using various forms of energy, including:
- Heated thermal balloons
- Different types of radiowaves
- Cryotherapy (freezing cold)
Depending on the method used, an endometrial ablation can be performed in a doctor's office or as an outpatient surgical procedure. It is often performed with a hysteroscopy.
- A hysteroscopy is an exam of the lining of the uterus. It is done using a thin, lighted tube with a camera on the end (hysteroscope).
- The hysteroscope is inserted into the vagina and advanced through the cervix into the uterus.
- After the uterus is examined, the endometrium is destroyed using the selected method. The type of energy your healthcare provider uses will be determined by your specific circumstances.
There are multiple causes of abnormal uterine bleeding. These causes include:
- Pregnancy and pregnancy-related complications
- Use of oral contraceptives or other birth control methods
- Infection, cancer, injury or other disorders of the uterus or cervix
- Blood-clotting disorders and chronic diseases, such as diabetes or thyroid disorders
- Recent injury or trauma to the cervix or uterus
- Certain medications or herbal supplements
- Hormonal factors
Some causes of abnormal uterine bleeding can be serious. If a specific cause is not found, abnormal uterine bleeding is generally thought to be due to hormonal factors. Contact your healthcare provider if you have vaginal bleeding that is different from your normal menstrual flow or occurs after menopause. Your provider will ask about your symptoms and do a physical exam, which will include an examination of your pelvic area (internal exam). They may also order:
- Lab work
- A pap smear
- An abdominal or vaginal ultrasound
Your healthcare provider may recommend a hysteroscopy and endometrial ablation if you have abnormal vaginal bleeding that has not been controlled with medication or other less invasive treatments.
- A hysteroscopy will first be done to evaluate the lining of your uterus and determine where and how the ablation will be performed.
- During the procedure, you will be lying on your back with your feet in stirrups. The position is similar to the position for a pap smear or other vaginal exam.
Endometrial ablation is not recommended for women who want to get pregnant or have:
- Abnormal cells in their uterus
- Been diagnosed with endometrial cancer
- A pelvic infection
- An IUD in place
- Had previous uterine surgeries
- A large or irregularly shaped uterus
In some cases, it may not be recommended for postmenopausal women.
Prior to the procedure, tell your healthcare provider about any medications you are taking (including over-the-counter medications and supplements). Ask about specific instructions you should follow before the procedure. These may include:
- Medications you should not take before the procedure, such as blood thinners or aspirin
- Regular medications you should continue to take on the day of your procedure
- How many hours you should stop eating and drinking before the procedure
- Any activity or dietary restrictions you should follow after the procedure
If you are a smoker, you should quit smoking. Smoking can interfere with your recovery.
During an endometrial ablation and hysteroscopy, you will receive some type of anesthesia to keep you comfortable and pain free.
- General anesthesia is the most common type of anesthesia for an endometrial ablation performed in a hospital. With this type of anesthesia, you are put into a deep sleep and are unable to see, hear or feel anything.
- Other types of anesthesia may be used for different types of endometrial ablations.
- You may experience some discomfort when the hysteroscope is inserted and when your uterus is filled with water or gas. A cervical anesthetic spray can help reduce the discomfort.
There may be a small amount of bloody vaginal discharge and cramping after the procedure.
- You should arrange to have someone drive you home after the surgery.
- You may need pain medication and help at home while you recover.
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What should I ask my healthcare provider before having an endometrial ablation?
- What is my diagnosis and reason for the procedure?
- Is there any other special preparation for the procedure? (If so, get clear instructions on what you need to do.)
- Will I have any type of sedation? What are the possible side effects?
- Are there any alternatives to this procedure?
- What are the possible risks/complications? How will I feel after the procedure?
- Will I have to modify my activity?
- What type of medication can I take to manage the pain after the procedure?
- When can I return to work and resume sexual activity?
- What symptoms might indicate a problem after the procedure?
- What will happen to me if I do not have this or any other procedure?
After your procedure, your healthcare provider should provide a description of any problems found during the procedure and what symptoms you should report.
- You should also understand all home care instructions (including medications and side effects) and follow-up plans.
- Your gynecologist should also let your primary care physician know the details of your procedure and treatment plan.