Endometrial ablation for Endometriosis

Overview
Menorrhagia, or excessive bleeding during menstruation, is a common symptom of endometriosis. Endometrial ablation is a procedure that destroys the endometrium, or lining of the uterus, to treat menorrhagia. Some women will have no further periods after endometrial ablation, while others will have lighter periods. The results of endometrial ablation may be temporary or permanent.

Endometrial ablation is an alternative to hysterectomy in women whose menorrhagia does not respond to hormonal therapies.

What does it involve?
Take time discussing endometrial ablation with your doctor. Ask them how many endometrial ablations they have performed, what techniques they have used, and what their rate of success for each is.

Your doctor might perform one or more procedures before you receive endometrial ablation. First, they might test for uterine cancer by obtaining an endometrial tissue sample. This test is performed by inserting a small instrument through the cervix. If you have an intrauterine device (IUD) form of birth control such as Mirena, it will have to be removed before the ablation procedure. Since endometrial ablation is most successful when the endometrium is thinnest, your doctor might also perform a dilation and curettage (also known as a D&C). During the D&C, an outpatient procedure, you will be anesthetized. The doctor will then insert an instrument into your cervix to remove endometrial tissue by scraping or applying suction.

There are different options for anesthesia during endometrial ablation. Some doctors may put you under general anesthesia in a hospital setting, whereas others may sedate you and then inject local anesthesia into your cervix and uterus before performing the ablation. If your doctor uses sedation and local anesthesia, the endometrial ablation may take place in their office.

Once you are anesthetized, the doctor will dilate your cervix, insert a hysteroscope (lighted camera) or resectoscope (lighted camera with a cutting tool), and perform the ablation. Many techniques are used for endometrial ablation; most make use of heat or cold to destroy the endometrial tissue. Heating techniques include using roller balls, spiked balls, loops, balloons, electrodes, or fluid heated using lasers, microwaves, radiofrequency, or electricity to destroy endometrial tissue. Cryoablation involves freezing the tissue using roller balls chilled to a very low temperature. Depending on the technique used, the procedure may take from 80 seconds to 30 minutes. Of these techniques, hydrothermal (using free-flowing, heated fluid) is the most painful, but also the most likely to provide complete coverage. Electrosurgery requires general anesthetic, while most other techniques can usually be performed in the doctor’s office under local anesthetic.

In the days after receiving endometrial ablation, you may experience cramps, watery vaginal discharge mixed with blood, and frequent urination. It may require several months before you see the final results of endometrial ablation.

Since endometrial ablation increases the risk of miscarriage or other problems during subsequent pregnancies, some women choose to undergo surgical sterilization at the same time. If you do not choose sterilization, it is important to continue using birth control after endometrial ablation.

Intended Outcomes
Endometrial ablation can significantly reduce menorrhagia.

Results
Approximately 90 percent of women who undergo endometrial ablation experience lighter periods or no periods for several years after the procedure.

An article published in 2015 reviewed clinical literature about endometrial ablation for the treatment of abnormal uterine bleeding caused by benign (non-cancerous) conditions. Researchers concluded that endometrial ablation was safe, effective, and minimally invasive.

Constraints
Endometrial ablation is not appropriate for postmenopausal women, women with uterine cancer, those who experience intense cramping during menstrual periods, or those who were recently pregnant or hope to become pregnant in the future.

You may experience pain, bleeding, or infection after endometrial ablation. In rare cases, the uterine wall might be punctured, or surrounding organs might be damaged during the process of endometrial ablation.

Endometrial ablation makes it more difficult or impossible to conceive a pregnancy. If you do become pregnant after endometrial ablation, there will be an increased risk of miscarriage or other problems for you or your baby.

Any use of general anesthetic carries the risk of stroke, heart attack, lung infection, or damage to teeth, tongue, or vocal chords.

Endometrial ablation may not be effective in decreasing your menstrual blood flow. Your endometrium may grow back, and menorrhagia may recur. The only procedure that can permanently stop your periods is a hysterectomy.

It may be more difficult for doctors to diagnose uterine cancer after you receive an endometrial ablation.