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Procedures - Endometrial Ablation

Endometrial ablation is a safe, proven procedure for the treatment of heavy menstrual bleeding otherwise known as menorrhagia. It has been performed in Calgary since 1991 and there are multiple studies which show its effectiveness. Prior to endometrial ablation, the only surgical method available to treat heavy periods in women who had not responded to, or wished not to utilize, medical treatment was hysterectomy.

Hysterectomy is 100% effective at eliminating menorrhagia but is major surgery requiring 2 to 4 days in hospital and up to six weeks recovery. Endometrial ablation, on the other hand, is an outpatient procedure (meaning that admission to the hospital is not required) and recovery is usually less than 3 to 4 days. In fact, many women undergoing endometrial ablation are able to return to work the next day, though the recommendation would be to take 2 to 3 days to rest following the procedure.

There are currently several methods available to perform endometrial ablation (e.g. electrocautery, hot water, laser, microwave, etc) but all have the same endpoint; that is they aim to destroy the lining of the uterus (the endometrium). The endometrium is the layer of tissue that lines the uterus and is approximately 4 to 5 mm thick. This is the tissue of the uterus which grows and is shed each month resulting in menstrual bleeding. The rest of the uterus is composed of thick muscle (the myometrium) and does not contribute to menstrual bleeding. Female hormones are produced by the ovaries which are well away from the endometrium. Thus, endometrial ablation affects only menstrual bleeding and does not affect hormones or put a woman into menopause.

Effectiveness of Endometrial Ablation at reducing Heavy Menstrual Bleeding

Studies of women undergoing endometrial ablation show that 5 years following the procedure about 75% are satisfied with the results (approximately half of those have no menstrual bleeding at all and the other half have light periods). The 25% who have a recurrence of menstrual bleeding will usually choose to have another endometrial ablation or a hysterectomy. Thus, endometrial ablation does not guarantee that you will never again have uterine bleeding or symptoms of menorrhagia, but it does provide an excellent method of reducing or eliminating your heavy periods.

Women who undergo endometrial ablation are very unlikely to be able to get pregnant following the procedure. Therefore, this is not a procedure for women who want more children. At the same time, endometrial ablation is not a contraceptive method and women who get pregnant after an endometrial ablation (the risk is about 1% if contraception is not used) have very high risk pregnancies. Therefore, some form of contraception is necessary following endometrial ablation in women who are sexually active.

Risks and Complications of Endometrial Ablation

Risks and complications with endometrial ablation are very rare but could include:

• pelvic cramping
• nausea and vomiting
• infection
• perforation of the uterus
• thermal injury to other tissues

Women who should not undergo endometrial ablation are those who:

• desire future pregnancies or may currently be pregnant
• have an active genital or urinary tract infection
• have a history of gynecologic cancer within the last 5 years

After the Endometrial Ablation Procedure

Afterwards you may experience some menstrual cramps which may last for a few hours or sometimes through to the next day. Most women have very little cramping. You should expect a brownish-bloody discharge following the procedure which may last up to six weeks. You should refrain from strenuous exercise for the next week and from intercourse for 3 weeks (to reduce the risk of infection). Most women will be back to full activity the following day.

Dr. Allan has performed more than a thousand endometrial ablations using several different techniques. He is an Assistant Clinical Professor at the University of Calgary and has been active in investigating and researching new techniques. He is the co-author of a published study evaluating the long term success of endometrial ablation.

Contact us to learn more about Endometrial Ablation and for a free consultation.