Endometrial Ablation

What is endometrial ablation?

Endometrial ablation is a surgical procedure that is performed to destroy  the lining of the uterus. This procedure is performed to reduce heavy menstrual flow. After this procedure, the menstrual flow completely stops in some women. No surgical cuts are made in this procedure. A slender tool is inserted through the vagina into the uterus. The tool can employ heated fluids, high-energy radiofrequencies, microwave energy, or extreme cold to destroy the endometrial lining. The procedure is done in the doctor’s office or an operating room. If the ablation does not control the heavy menstrual flow, further treatment or surgery may be required.

Pre-surgery care

Before beginning the operation, the doctor will:

• Conduct a pregnancy test since endometrial ablation cannot be done during pregnancy.
• Test a sample from the endometrium to check for cancer.
• Remove any intrauterine device.
• Perform a dilatation and curettage or give medications to scrape out excess tissue from the endometrium for the surgery to be more effective.
• Provide options for anesthesia.

Endometrial ablation procedure

The opening of the cervix is widened for the passage of  instruments during endometrial ablation using a medication or a series of rods that progressively increase in diameter. Once the cervix is dilated, the tools for the selected method of ablation are inserted to remove the endometrial lining.

The various methods of endometrial ablation are:

Cryoablation

Two or three ice balls are created using extreme cold that destroy the endometrium by freezing it. The progress of the ice balls is tracked using an ultrasound. Each freeze cycle goes on for up to six minutes. The number of freeze cycles varies from patient to patient depending upon the size and shape of the uterus.

Microwave

While using the microwave method for endometrial ablation, a lean wand is placed inside the cervix. This wand emits microwaves that generate heat in the endometrial tissue. The treatment normally lasts for approximately three to five minutes.

Electrosurgery

General anesthesia is required during electrosurgery. A slender scope is placed inside the uterus to see the inside of the uterus. An instrument like a wire loop is passed through the scope. It is heated and used to create grooves into the endometrium.

Heated balloon

In the heated balloon method, a balloon device is placed in the cervix and inflated with heated fluid. The procedure takes from two to ten minutes depending upon the type of balloon device.

Radiofrequency

A special radiofrequency instrument that opens up into an ablation device is inserted into the uterus. This device emits radiofrequency energy that vaporizes the endometrial tissue within one or two minutes.

Free-flowing hot fluid

Saline fluid is heated and circulated inside the uterus for approximately 10 minutes. This method can be used in women who have abnormal tissue growth such as uterine fibroids or intracavity lesions in the uterus, leading to an irregularly shaped uterus.

Post-surgery care at home

Following are some do’s and don’ts once you are home after the endometrial ablation procedure:

Do’s

• Consume adequate amount of clear liquids; stay hydrated.
• You may have a reduced appetite due to the pain medications or the anesthesia. You can eat whatever you feel your stomach can tolerate.
• Avoid sports and strenuous activities for about a week after the surgery.

Don’ts

• General anesthesia or intravenous anesthesia can stay in your body for 24 hours. You should avoid driving a motor vehicle, taking any business decisions, operating heavy machinery, or consuming alcohol for the next 24 hours. Relax for the rest of the day.
• You can go back to your routine in a day or two. Do not have sexual intercourse and do not use tampons until your post-operative doctor visit or for at least a week. Avoid douches for at least two weeks as there are chances that they may cause an infection.
• You may experience cramps for some days after the surgery. Your doctor may prescribe mild analgesics or non-steroidal anti-inflammatory medicines like ibuprofen to ease the pain.
• While the healing process takes place, you may have bloody discharge from your vagina occasionally. Wear a pad. The discharge will reduce as you heal.
  You can shower whenever you feel comfortable. Do not soak in the bathtub or hot tub or swim for two to four weeks to help prevent an infection.

Complications of endometrial ablation

The possible effects of endometrial ablation are:

• Frequent urination for 24 hours after the surgery
• Watery, thin discharge with blood that can last for a few weeks. The discharge might be heavy for two to three days after the procedure
• Nausea
• Cramps similar to menstrual cramps for one to two days

Complications that are linked to the endometrial ablation procedure are:

• Bleeding and infection.
• The device used in the procedure might perforate the bowel or the uterine wall.
• Some methods may cause burns to the bowel, vagina, or the vulva.
• The procedure may not be completed due to problems inside the uterus or due to internal narrowing of the cervix. This might require further surgery.
• In rare cases, the fluids used during the procedure to stretch the uterus can get absorbed in the uterus and cause coma or even be fatal.
• Pregnancies after endometrial ablation may end up in miscarriages as the lining of the uterus is damaged in the ablation procedure. The chances of ectopic pregnancy, (pregnancy in the fallopian tubes or the cervix instead of the uterus become high.

References:

https://www.nwh.org/surgery/surgical-discharge-instructions/endometrial-ablation-instructions
https://www.mayoclinic.org/tests-procedures/endometrial-ablation/about/pac-20393932
https://www.acog.org/~/media/For%20Patients/faq134.pdf
https://www.hopkinsmedicine.org/healthlibrary/test_procedures/gynecology/endometrial_ablation_92,p07774
https://www.nwh.org/media/file/post-op-ablation.pdf

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