Endometrial ablation is a minimally invasive procedure aimed at removing the thin inner lining of the uterus. It is recommended in cases of heavy menstrual bleeding or abnormal uterine bleeding (bleeding between menstrual periods).
What is endometrial ablation?
Endometrial ablation is a gynecological procedure in which the endometrium (the thin tissue lining the uterus) is removed. Following the procedure, the amount of blood flow during menstruation decreases, and uterine bleeding is alleviated.
Typically, endometrial ablation is recommended for women between the ages of 35 and 45, with an ideal age of over 40. After menopause, endometrial ablation is generally not advised due to the risk of uterine cancer.
Indications and contraindications
Endometrial ablation is recommended for patients who experience heavy menstrual bleeding. Signs of heavy menstrual bleeding include:
- Needing to change tampons or pads every hour or more frequently.
- Bleeding lasting more than 8 days.
- Diagnosis of anemia due to blood loss.
For heavy menstrual bleeding, a doctor may initially recommend controlled oral contraceptives or an intrauterine device. If these treatments or others do not provide relief, endometrial ablation may be suggested.
The procedure has consequences (such as reducing pregnancy chances), so there are contraindications to its performance:
- Planning pregnancy.
- Confirmed precancerous condition of the endometrium or uterine cancer through histological examination.
- Infectious disease or inflammation of the internal organs of the pelvis.
- Insufficient stitches.
- Sexually transmitted diseases.
- Acute exacerbation of chronic diseases.
- Presence of an endometrial polyp or fibroids.
Endometrial ablation is not performed if the muscular layer is less than 1 cm thick. Typically, the procedure may be contraindicated if the length of the uterus is less than 4 cm or more than 11 cm. However, some modern technologies allow ablation even with a uterine length of up to 14 cm.
Risks of the Operation
The procedure has potential consequences, such as reduced chances of conceiving, carrying a pregnancy to term, or giving birth. For this reason, the procedure is rarely performed on women of reproductive age.
If the operation does result in infertility or pregnancy complications, a woman may consider the services of a reproductive clinic that offers surrogacy.
Methods of endometrial ablation
The removal of the endometrium from the uterine cavity can be achieved using various methods, including:
- Laser Ablation (contact or non-contact).
- Electrosurgical methods involving a ball electrode, roller, rollerball, or loop. This method is considered less traumatic.
- Radiofrequency ablation, in which tissues are vaporized using instant high-temperature coagulation.
- Thermal fluid ablation, which removes the tissue layer using a contact method.
- Cryotherapy, involving the application of liquid nitrogen to the endometrium.
To ensure constant monitoring, a hysteroscope with a camera and light source is inserted into the uterine cavity.
Endometrial ablation procedure
Before the intervention, patients undergo a comprehensive examination. The gynecologist conducts a visual examination on the gynecological chair. Diagnosis also includes a detailed
blood and urine analysis, testing for hidden infections, smears from the cervical canal, and instrumental examinations.
Despite being minimally invasive, the procedure may require the patient to stay in the hospital for 1-2 days. The recommended time for the procedure is between the 5th and 8th day of the menstrual cycle. The steps of endometrial ablation are as follows:
- The woman lies on the operating table or gynecological chair, depending on the type of ablation.
- The doctor inserts a speculum into the vagina and treats the cervix with an antiseptic solution.
- The doctor secures the cervix and ensures free access to the inner part of the organ.
- A hysteroscope is inserted into the uterus.
- The uterine cavity is filled with fluid or carbon dioxide gas to improve visibility (optional).
- The doctor removes the endometrium.
- If fluid was introduced, it is drained from the uterine cavity.
The specifics of the procedure may vary depending on the type of ablation. Depending on the type of ablation, general or spinal anesthesia, as well as pain-relieving injections into the cervix and uterus, may be used. If there are no complications during and in the first few hours after the procedure, the patient may be discharged home on the same day.
Postoperative period
In the first few days after uterine endometrial ablation, there may be bloody discharge and cramping in the lower abdomen. Watery discharges may persist for 1-2 weeks.
Initially, the patient should avoid physical exertion and monitor their emotional state. It is recommended to add more vitamin-rich foods to the diet.
For the first 2-3 days (or longer as advised by the doctor), tampons should not be used, and sexual intercourse should be avoided.
Recovery typically takes between 2 and 14 days. Most women can return to their regular work activities within 1-5 days after the ablation procedure.