Ablation, Endometrial (Endometrial Ablation)

Endometrial ablation is an approximately 45 minute out-patient procedure that destroys (ablates) the uterine lining, or endometrium. It is used to treat abnormal uterine bleeding and could be performed using local, spinal or general anaesthesia.

Why It is Done? 

• To control heavy, prolonged vaginal bleeding not responding to other treatments

• Childbearing is over

• As preference over hysterectomy 

Risks of Endometrial Ablation

• Accidental uterus puncture 

• Thermal injury to the uterus or bowel

• Fluid buildup in lungs

• Blockage of arterial blood flow in lung 

• Tearing of cervical 

How to prepare for Endometrial ablation procedure?

• Pregnancy check. Endometrial ablation can't be done during pregnancy.

• Cancer detection. A thin tube is inserted through your cervix to obtain a small sample of your endometrium.

• Removing IUD. Endometrial ablation isn't performed with IUD.

• Thinning the endometrium. As some endometrial ablation are more successful when the uterine lining is thin, Doctor might prescribe medications. 

• Anaesthesia options:  Depending on the case

Methods of performing Endometrial Ablation 

• Electro surgery:  A slender scope is used to see inside the uterus while an instrument is passed through the scope, such as a wire loop  heated and used to carve furrows into the endometrium. It shall require general anaesthesia.

• Cryoablation. Extreme cold is used to create 2-3 ice balls that freeze and destroy the endometrium. Real-time ultrasound enables the doctor to track the progress of the ice balls. Each freeze cycle takes up to 06 minutes, and  no. of cycles needed depends on the size and shape of the uterus.

• Free-flowing hot fluid. Heated saline fluid is circulated within the uterus for nearly 10 minutes. It can be performed in women with an irregular-shaped uterus. 

• Heated balloon. A balloon device is inserted through your cervix and inflated with heated fluid. The procedure can take from 02 -10 minutes, depending on the kind of balloon device, 

• Microwave. A slender wand is inserted through the cervix. The wand emits microwaves that heat the endometrial tissue. Treatment usually lasts 03-05 minutes.

• Radiofrequency. A special instrument unfurls a flexible ablation device inside the uterus that  transmits radiofrequency energy to vaporise the endometrial tissue in 1-2 minutes. The device is later removed from the uterus.

After the Procedure

• Cramps. You may have menstrual-like cramps for a few days for which  medications can help.

• Vaginal discharge. A watery discharge, mixed with blood, may occur for a few weeks. The flow is typically heaviest for the first few days.

• Frequent urination. You may need to pass urine more often during the first 24 hours 

Results

Endometrial ablation usually reduces the amount of blood during menstruation. Most women will have lighter periods, and some may stop having periods completely.

It is not a sterilisation procedure so it is advisable for use contraceptives after the procedure to avoid unwanted pregnancy.