Endometrial ablation is a procedure where the endometrial lining is removed or destroyed to reduce menstrual bleeding. This technique is most often employed for women who suffer from excessive or prolonged bleeding during their menstrual cycle but cannot or do not wish to undergo a hysterectomy. The procedure is most commonly done as a day case, but may need an overnight stay in the hospital. Endometrial ablation should not be done in patients who may want to get pregnant.
Endometrial ablative techniques require introducing the hysteroscope to visualise the endometrial lining and then using either a thermal or an electro-surgical device to destroy the lining. Some patients may stop having periods and some may continue to have periods but much lighter. The classical method, endometrial resection, uses electric current in a small loop to strip away the endometrial lining. Newer methods of endometrial destruction include the Novasure system where a mesh is introduced into the cavity and the endometrium destroyed by applying electrical energy to the mesh that will thermally damage the adjacent endometrium. Seventy eight percent (78%) of patients have a successful reduction in bleeding down to normal levels.
After any ablative procedure, the endometrium heals by scarring, thus reducing or removing the possibility of future uterine bleeding. Although periods will reduce or even stop, hormonal functioning remain unaffected. Although rare (0.7%), it is still possible to become pregnant after having this procedure which carries severe risks to both mother and baby. A contraceptive method must be used after having endometrial ablation.
Approximately 80% of women who undergo this procedure find the results satisfactory. Of those, approximately 35% stop having periods altogether.
Although uncommon, the procedure can have serious complications including perforation of the uterus, burns to the uterus (beyond the endometrial lining) and to surrounding structures like bowels, pulmonary edema or embolism.