Endometrial ablation is a quick outpatient treatment for heavy bleeding.

Endometrial ablation is the removal or destruction of the endometrium (lining of the uterus). It does not require hospitalization, and most women return to normal activities in a day or two. Ablation is an alternative to hysterectomy for many women with heavy uterine bleeding who wish to avoid major surgery. After a successful endometrial ablation, most women will have little or no menstrual bleeding. Patient selection and physician experience is essential to a good outcome.

How is endometrial ablation done?

Endometrial ablation has traditionally been done using a hysteroscope. The procedure was developed by Dr. Goldrath in 1979 using a Nd:YAG laser. I did the first endometrial ablation in Northern California in 1985 using the laser. My results using the laser were excellent, but because of research done by myself and others, I switched to an instrument called a resectoscope. The resectoscope is a special type of telescope that allows me to see inside the uterus. It has a built in wire loop that uses high-frequency electrical energy to cut or coagulate tissue.

The resectoscope has the advantage of being able to remove polyps and some fibroids at the time of ablation. In results reported to the FDA where resectoscopic endometrial ablation was done by experts, the success rate was approximately 95%, with 40% of women having no bleeding whatsoever in 1 year. In my own patients treated with the resectoscope as part of those trials, 58% of women had no bleeding at all after 1 year. It takes extensive experience and skill to be able to safely use the resectoscope, and obtain this degree of success.

What is a "balloon ablation?" What about other devices?

Although the resectoscope provides excellent results in experienced hands, the technique is difficult to master. Other methods of ablation have been investigated. The first to obtain FDA approval was the Thermachoice™ balloon. This uses a balloon placed in the uterine cavity through the cervix. Hot water is circulated inside the balloon to destroy the endometrium. Some experts are concerned about the balloon's ability to reach the cornual areas (the "top corners") of the uterus. Although the balloon's "success" rate in FDA studies was reasonable, it had a much lower rate of amenorrhea the other currently available device — only 13%. I see no advantages and many disadvantages to it's use, so I do not recommend this device.

The HTA Hydrothermablator^® also uses hot water, but allows it to circulate freely in the endometrial cavity. It is done under direct vision through a hysteroscope. Once the proper temperature is reached, the hot water circulates for 10 minutes. One of the original concerns was about the possibility of fluid leaking out the fallopian tubes and burning intestines. Although this did not happen in clinical studies, a case of an intestinal burn is being reviewed by the FDA.

There are other devices available in this country and other countries, but I think that their disadvantages outweigh their advantages.

The Novasure System

Another new device, the Novasure System™ , is now available, and has a number of advantages over other systems. It only takes a few minutes and has an excellent safety record. Click here for more information on the Novasure System™

Recovery from endometrial ablation

Most women are able to go home within an hour after the an endometrial ablation. There may be mild cramping, which can usually be relieved by ibuprofen. Occasionally stronger medicine may be needed. It is normal to be tired for a few days, but most women are able to return to most normal activities in a day or two. Intercourse and very strenuous activity is usually restricted for 2 weeks. It is normal to have a increased discharge for 2 to 4 weeks afterward, as the lining is shedding. I normally do the first check-up 4 weeks afterwards.

Who should consider endometrial ablation?

Women who have menstrual bleeding that is impacting their life, and do not have other problems that require a hysterectomy should consider endometrial ablation.

	You limit your activity because of your periods.
	Bleeding is causing you to be anemic and tired
	Bleeding limits your intimate time with your partner?
	You do not desire to retain fertility

Risks of endometrial ablation

As with any surgical procedure, there are risks, which should be compared to the risks of things we do in every day life. A number of things can be done to reduce these risks. Some of the risks of endometrial ablation procedures are perforation of the uterus, absorbing excess fluid, bleeding, infection, injury to organs within the abdomen and pelvis, and accumulation of blood within the uterus due to scarring. Another rare, but important, concern after any endometrial ablation procedure is that it might decrease your doctor's ability to make an early diagnosis of cancer of the endometrium. Abnormal bleeding should be evaluated whether or not you have had an ablation.

A small percentage of properly selected women having an ablation will still eventually need a hysterectomy, but the vast majority will not. Having done endometrial ablation since 1985, I can often identify women who will have a successful ablation and those who would be better off with other treatment.

Who shouldn't have an endometrial ablation?

Since an endometrial ablation destroys the lining of the uterus, endometrial ablation is not for anyone who desires to keep her fertility. Women who have a malignancy or pre-malignant condition of the uterus are not candidates for ablation. Women who have severe pelvic pain, unless the pain is coming from an intracavitary myoma, may be better served by alternative treatments. Although pregnancy is unlikely after ablation, serious complications could arise. It is essential for to use reliable contraception after an endometrial ablation.

Who can help me decide if an endometrial ablation is for me?

It is helpful to see a gynecologist who is familiar with, and who is able to provide all of the alternatives for the treatment of your problem. A physician who does not do endometrial ablation on a regular basis is unlikely to have the experience to help you make the best decision. The physician should be expert at vaginal-probe ultrasound and at diagnostic hysteroscopy, and should consider non-surgical treatments, as well as discussing the advantages and disadvantages of all the options available. While the physician can provide you with information, the decision is ultimately yours.

The medical information presented in this website represents the opinion of Dr. Indman, and is based on his knowledge and experience. It is not applicable to all patients or physicians. Anyone visiting this or other related medical sites should discuss symptoms, findings, and alternatives with their personal gynecologist.