What is endometrial ablation and what is it done for?

Endometrial ablation is a surgical procedure performed to remove the endometrium. This is a lining of the uterus that, under normal conditions, serves to feed the fetus if fertilization occurs.

In each menstrual cycle, the endometrium thickens due to the action of the hormones estrogen and progesterone. If there is no fertilization, the endometrium, along with blood and mucus, becomes the menstrual flow that is expelled during the rule.

The goal of endometrial ablation is to minimize menstrual flow when it is excessive or too long. This procedure can be done in a doctor's office or surgery room.

When is endometrial ablation recommended?

In general terms, endometrial ablation is done when a woman has menorrhagia. This is a condition in which menstruation is very heavy, prolonged, or there is bleeding between two periods. In severe cases, this prevents daily tasks or causes anemia.

It is considered that bleeding is excessive when a woman should change her sanitary products (sanitary napkins or tampons) every hour. It is said to be prolonged if it lasts more than seven days. One of the ways to solve these problems is through endometrial ablation.

This procedure is not recommended if a woman wants to get pregnant. in the futureas it can sometimes affect fertility. Many other times it leads to a miscarriage or high-risk pregnancy if there is fertilization.

Endometrial ablation is not recommended for women who are postmenopausal or who have any of these difficulties:

• Active pelvic infection.
• Cancer in the uterus.
• Certain abnormalities in the uterus, in the judgment of the doctor.

Previous preparation

It is very important to be very well informed before undergoing endometrial ablation.. It is quite likely that it will be necessary to sign a consent before this surgery. The most common is that prior to the procedure the following actions are carried out:

• A pregnancy test. Surgery cannot be carried out if there is pregnancy.
• Endometrial biopsy. It is done to rule out the presence of cancer in the uterus.
• Removal of the intrauterine device, if there is.
• Thinning of the endometrium. Endometrial ablation is more successful if the lining is thin. You lose weight with medicine or through a D&C procedure.
• Discuss anesthesia options. This can be local or general depending on the procedure to be performed.

Also read: Do you suffer from heavy menstrual bleeding?

In the days leading up to the procedure, the ingestion of some medications may be prohibited. Sometimes a medicine is ordered to dilate the cervix about 8 to 12 hours before surgery.. On the other hand, you may not be able to drink or eat for 6 to 12 hours before the intervention.

How is it the procedure?

There are several techniques for performing endometrial ablation. They all aim to destroy endometrial tissue and they do it in different ways. Among them are the following:

• Electrosurgery. It is done with a device called a resectoscope and an instrument that uses heat.
• Cryoablation. An elongated probe is used to apply extreme cold.
• Fluid hot liquid. Warm saline fluid is put into the uterus for 10 minutes.
• Thermal balloon. A balloon is inserted into the uterus, inflated, and heated.
• Microwave. A probe that generates microwave energy is inserted.
• Radio frequency. It is carried out with a flexible device that emits radio frequency energy.

The different techniques make up two large groups: procedures that use a hysteroscope or resectoscope, and the others. Accordingly, endometrial ablation is carried out as will be explained below.

Initial steps in all techniques

First, the patient is asked to remove her clothing and put on a hospital gown. Then an IV is placed in your hand or arm. Later, lie down in the position adopted for a pelvic exam.

The doctor inserts a speculum to separate the walls of the vagina and allow the cervix to be exposed. The cervix is ​​cleaned with an antiseptic solution. From then on, there are slight variations depending on the technique used.

Techniques using hysteroscope or resectoscope

The techniques that use hysteroscope or resectoscope are: electrosurgery, microwave and fluid hot liquid. The procedure in these cases is carried out as follows:

• Anesthesia is applied.
• In some cases, a urinary catheter is inserted.
• Sometimes an instrument called a tenaculum, similar to a forcep, is used to hold the cervix firm while the procedure is being performed.
• A series of rods is introduced, each one with a greater diameter than the previous one., to widen the opening of the cervix and insert the hysteroscope or resectoscope.
• Sometimes a liquid solution or gas is introduced to fill the uterus and make it easier to see.

• The ablation instrument or substance is introduced and put into action to destroy the tissue.
• All the liquid is pumped out and the instruments are removed.

Other techniques

The other techniques correspond to endometrial ablation with thermal balloon, cryoablation and radiofrequency. In this case, the initial steps are carried out, as well as the following actions:

• The area is numbed by a medicine given as a local injection.
• Sometimes a uterine tube is inserted to establish the length of the uterus and cervical canal. Then he retires.
• Depending on the case, a silicone balloon, a triangular mesh of electrodes or a probe that produces very cold temperatures is inserted.
• Endometrial tissue is destroyed through hot liquid in the balloon, radio frequency energy or extreme cold, depending on the technique used.
• Instruments are removed.

Recovery after the procedure

After the procedure, the patient is transferred to a recovery room where he must remain under observation for a couple of hours. When the vital signs are stable, she is discharged or referred to a room, as the case may be.

Typically, the following symptoms occur after endometrial ablation.

• Colic. They are similar to menstrual cramps and usually last between one and two days. They are controlled with over-the-counter pain relievers.
• Vaginal discharge. There is a watery discharge mixed with blood, more abundant at first and less and less profuse. It usually stays for a week or two.
• Need to urinate frequently. This symptom occurs during the first 24 hours after the procedure.

Typically, normal activities can be resumed after a couple of days. You should not have sex, use tampons, or douche for the next two to three days. No strenuous activity or exertion may be recommended for a week.

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Risks and complications

Endometrial ablation is a safe procedure that rarely has complications. In very rare cases, one of the following conditions may occur:

• Perforation of the uterine wall or intestines.
• Thermal injuries to the uterus or intestinal wall.
• Pulmonary edema; that is, fluid accumulation in the lungs.
• Pulmonary embolism: a blockage of blood circulation within the lung.
• Tear of the cervix.
• Infection or bleeding.
• Thermal injury damage to the vagina or vulva.
• Allergic reaction.
• Endometrial ablation failure. That is, the endometrium grows back abnormally after surgery.

It is necessary to seek medical attention if any of the following symptoms occur after the procedure:

• Fever or chills.
• Foul-smelling discharge
• Excessive pain in the area.
• Excessive bleeding.
• Bleeding after two days of surgery.

• Difficulty urinating.

Consult with your doctor to make a decision

The vast majority of women stop having heavy or prolonged periods after endometrial ablation. It is estimated that between 30 and 50% stop having periods completely. This is more common in older women.

Younger women are at higher risk of needing a second procedure. It is important to emphasize that endometrial ablation should not be performed if pregnancy is planned. It is also not suitable in women at risk of developing uterine cancer.