Endometrial Ablation

Dr. Madejski is happy to offer in office ablation of the uterine lining. This procedure is an alternative to a hysterectomy that is done for abnormal uterine bleeding. In the past, a woman would have to go to a hospital and receive anesthesia to have a global endometrial ablation – permanent treatment of heavy menstrual bleeding. Now, the great majority of our patients are opting for a convenient in office procedure.

What is endometrial ablation?
Endometrial ablation destroys a thin layer of the lining of the uterus. Menstrual bleeding will either stop entirely or is greatly reduced to acceptable levels. If ablation does not control heavy bleeding, further treatment or surgery may be needed.

Why is endometrial ablation done?
Endometrial ablation is used to treat many causes of heavy bleeding. In most cases, women with heavy bleeding are treated first with medication. If heavy bleeding cannot be controlled with medication, endometrial ablation may be used.

Who should not have endometrial ablation?
Endometrial ablation should not be done in women past menopause. It is not recommended for women with certain medical conditions, including the following:

  • Disorders of the uterus or endometrium
  • Endometrial hyperplasia
  • Cancer of the uterus
  • Recent pregnancy
  • Current or recent infection of the uterus

Can I still get pregnant after having endometrial ablation?
Pregnancy is not likely after ablation, but it can happen. If it does, the risks of miscarriage and other problems are greatly increased. If a woman still wants to become pregnant, she should not have this procedure. Women who have endometrial ablation should use birth control until after menopause. Sterilization may be a good option to prevent pregnancy after ablation.

A woman who has had ablation still has all her reproductive organs. Routine cervical cancer screening and pelvic exams are still needed.

What techniques are used to perform endometrial ablation?
The following methods are those most commonly used to perform endometrial ablation:

  • Radiofrequency—A probe is inserted into the uterus through the cervix. The tip of the probe expands into a mesh-like device that sends radiofrequency energy into the lining. The energy and heat destroy the endometrial tissue, while suction is applied to remove it.
  • Freezing—A thin probe is inserted into the uterus. The tip of the probe freezes the uterine lining. Ultrasound is used to help guide the procedure.

What should I expect after the procedure?
Some minor side effects are common after endometrial ablation:
Cramping, like menstrual cramps, for 1–2 days
Thin, watery discharge mixed with blood, which can last a few weeks. The discharge may be heavy for 2–3 days after the procedure.
Frequent urination for 24 hours
Nausea

What are the risks associated with endometrial ablation?
Endometrial ablation has certain risks. There is a small risk of infection and bleeding. The device used may pass through the uterine wall or bowel. With some methods, there is a risk of burns to the vagina, vulva, and bowel. Rarely, the fluid used to expand your uterus during electrosurgery may be absorbed into your bloodstream. This condition can be serious. To prevent this problem, the amount of fluid used is carefully checked throughout the procedure.

Minerva Endometrial Ablation
Minerva is the first new endometrial ablation device on the market in the last 15 years and was designed address some of the drawbacks of previous endometrial ablation systems. Specifically, Minerva reduces patient discomfort during and after the procedure, provides additional safety features, and improves the percentage of patients who experience a complete cessation of their menstrual bleeding. The Minerva system uses three methods to burn the lining of the endometrial cavity and in so doing can use less energy to achieve a more complete treatment of the surface of the entire cavity. After initial measurements of the uterine cavity, a silicone lined membrane is introduced into the endometrial cavity. This membrane is filled with argon gas which is heated until it becomes plasma. The heat from the plasma heats the silicone membrane that is in contact with the surface of the womb cavity. This heat desiccates the endometrium. Heat from the silicone membrane also heats the small amount of fluid that is typically present in the womb cavity to allow superficial burning of any part of the endometrium that is not in direct contact with the silicone membrane. Finally, a portion radio frequency energy used to heat the argon gas also heats the endometrium but with less energy than other radio frequency ablations like Novasure. The use of less energy results in less pain and cramping during the procedure, which means that it can be performed with a patient fully awake in the office under a local anesthetic block of the cervix. Most patients experience only mild to moderate cramping or pressure. The procedure itself takes four minutes to complete. In a study to assess the effectiveness of the Minerva endometrial ablation device, 92% of women who underwent the Minerva endometrial ablation a significant reduction in their bleeding and 66% had no bleeding at all after the procedure. Overall, 98% of those women were satisfied with their procedure. Rates of post-procedure bleeding, cramping, discharge, bloating, and nausea were all low.

Women who are the best candidates for an endometrial ablation procedure are those who have not gone through menopause yet, have bothersome heavy menstrual bleeding, do not desire to have more children, have a method of permanent contraception, and have completed an evaluation to determine the cause of their bleeding and to assess the size and shape of the womb cavity. Patients who have postmenopausal bleeding, have precancerous changes to the womb cavity lining, or have uterine fibroids that protrude into the endometrial cavity are not good candidates.

Glossary
Cervix: The lower, narrow end of the uterus at the top of the vagina.
Endometrial Hyperplasia: A condition in which the lining of the uterus grows too thick. A specific type of endometrial hyperplasia may lead to cancer.
General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.
Menopause: The time in a woman’s life when menstruation stops; defined as the absence of menstrual periods for
12 months.
Pelvic Exam: A physical examination of a woman’s reproductive organs.
Sterilization: A permanent method of birth control.
Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.
Vulva: The external female genital area.