Dear Doctor Column, January 17, 2005

Endometrial Ablation Considered Safe Procedure

Question:

What exactly is endometrial ablation? Is it safe? I'm considering it, but am reluctant to proceed. I'm in my late 40's with no other health problems.

Answer:

Endometrial ablation is the removal or destruction of the lining of the uterus called the endometrium. It has been performed in the United States for more than a decade. Although all surgical procedures carry risks, endometrial ablation is considered a generally safe procedure, does not require hospitalization, and most women return to normal activities within a few days.

Ablation is an alternative to hysterectomy for many women with heavy uterine bleeding (known medically as menorrhagia) who wish to avoid major surgery and for whom other medical and drug treatment options have failed. Menorrhagia is a common problem with a variety of causes including hormonal disturbances, uterine fibroids, polyps, overgrowth of the uterine lining (with or without precancerous changes), or cancer. Both endometrial ablation and hysterectomy preclude further childbearing and should not be considered by women who may wish to become pregnant.

The uterus consists of two parts — an outer muscular part called the myometrium and an inner lining, the endometrium. Each month, hormonal changes cause the lining to thicken in readiness for pregnancy. If conception does not occur, the lining of the uterus sloughs off, leading to menstrual bleeding. Since menstrual blood arises entirely from the endometrium, its destruction effectively halts or reduces the amount of bleeding with periods and sometimes halts them completely.

A variety of different methods may be used to destroy the uterine lining, including laser energy, radio waves, electricity, hot water, freezing, and a heated loop. In all cases, a viewing tube (hysteroscope), containing a camera and light source, is passed into the uterus through the vagina and cervix. This allows the doctor to view the inside of the uterus on a television monitor.

Endometrial ablation is an outpatient surgical procedure. Recovery is normally quick, with a return to normal activities within a week. Slight cramping pain may occur in the lower abdomen for several hours after the procedure, usually controlled by over-the-counter pain medications, such as ibuprofen. A small amount of vaginal bleeding usually occurs for a few days.

There is a small risk of infection resulting in pelvic pain, discharge, or vaginal irritation. Complications from endometrial ablation procedures are few but may include uterine perforation (puncturing a hole in the uterus), which may result in hemorrhage or bowel injury.

According to recent studies, most women feel endometrial ablation relieves the problem with their period. According to the American Society for Reproductive Medicine, approximately 90% of women experience relief of their symptoms within the first few months, with many having very light or absent menstrual periods after the procedure. Younger women are less likely than older women to respond to endometrial ablation. Additionally, younger women are more likely to continue to have periods after ablation and need a repeat procedure.