If you experience heavy bleeding or abnormal bleeding throughout your menstrual cycle, or have spotting or irregular intervals between periods, navigating around your menstrual cycle can seem incredibly inconvenient and frustrating. For some, it may be downright unbearable.

If you’ve tried less invasive treatments, such as hormonal medication, and you’re still experiencing debilitating symptoms, you may be wondering if anything else can be done short of major surgery or just “waiting it out” until menopause.

Thankfully, there is a minimally invasive procedure that can be a great alternative. It’s called endometrial ablation. But what exactly is endometrial ablation, what are the risks, and who is a good candidate? We asked Kimberly Kho, M.D., an OB/GYN and physician on the medical staff at UT Southwestern Medical Center, to find out.

Endometrial Ablation

Simply put, endometrial ablation involves the surgical removal of the lining of the uterus, which is typically built up and then shed each month during menstruation. After the ablation, your uterus will not be able to adequately build up that lining again, thus reducing or possibly completely stopping the monthly bleeding you experience during your period.

While this may sound like a major operation, the procedure is usually outpatient and minimally invasive.

There are a few different methods to destroy the uterine lining, but Kho notes the most common method uses a high level of heat to essentially cauterize the lining.

Who is a Good Candidate?

There are some cases in which endometrial ablation should not be performed. According to the American College of Obstetricians and Gynecologists, endometrial ablation should not be done in women who are post-menopausal or have the following medical conditions:

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

To rule some of these out, your physician will sample the endometrium. Sampling of the uterus usually takes place in the office with an endometrial biopsy, in which a small amount of the tissue is removed and examined under a microscope.

If you have a family history of endometrial cancer, or have had endometrial hyperplasia before, you may not be a good candidate, ablation is not recommended due to the difficulty to obtain an endometrium sample after the procedure in order to screen for cancer.

Additionally, women who have had multiple cesarean sections (C-sections) or large myomectomies can have a thinner-than-usual uterus, which might increase the risks of surgery.

Endometrial ablation is also not recommended for women who still plan on getting pregnant in the future. While it is still possible to become pregnant after the procedure if a small patch of endometrial tissue has been overlooked and left behind, which Kho notes is rare, pregnancy after endometrial ablation can pose a significant health risk to both the mother and baby. This risk becomes more likely the younger you are.

“I see some women in their 20s who tell me they don’t want babies and they hate their periods and want them to go away. I understand that — however, this isn’t always a good option for women so young because their bodies will still experience a hormonal response for 20 years or longer before hitting menopause,” Kho explains. “With functioning ovaries, their body will try to create an environment in their uterus for a viable pregnancy each ovulation cycle. This process can cause tiny areas of uterine lining tissue to try to grow back. The longer a woman is exposed to that, the higher the risk that her uterine lining will grow back.”

What Should I Expect?

Prior to the procedure, your doctor may recommend you stop certain medications up to one week beforehand. Additionally, you may be prescribed medication to thin the lining of the uterus. Depending on the method used, you may need to arrange for someone to drive you home afterward, as well as care at home. You should also avoid smoking prior to and after the procedure to prevent complications.

Ablation is typically a short procedure. Your cervix may be dilated (opened) before the procedure to help your physician easily navigate the uterus. There are no incisions or cuts involved with 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.
• Heated fluid – Fluid is inserted into the uterus through a hysteroscope. The fluid is heated and stays in the uterus for about 10 minutes. The heat destroys the lining.
• Heated balloon – A balloon is placed in the uterus with a hysteroscope. Heated fluid is put into the balloon. The balloon expands until its edges touch the uterine lining. The heat destroys the endometrium.
• Microwave energy – A special probe is inserted into the uterus through the cervix. The probe applies microwave energy to the uterine lining, which destroys it.
• Electrosurgery – Electrosurgery is done with a resectoscope. A resectoscope is a thin telescope that is inserted into the uterus. It has an electrical wire loop, roller-ball, or spiked-ball tip that destroys the uterine lining. This method usually is done in an operating room with general anesthesia and is therefore not as frequently used as the other methods.

Depending on the type of pain relief, and if general anesthesia was used, recovery can take about 2 hours.  

Some minor side effects that are common after endometrial ablation include:

• Cramping, like menstrual cramps, for 1 to 2 days
• Thin, watery discharge mixed with blood, which can last a few weeks. The discharge may be heavy for 2 to 3 days after the procedure.
• Frequent urination for 24 hours
• Nausea

Your physician will most likely discuss with you when it is safe to resume exercise, have sex, or use tampons. In most cases, you can expect to go back to work or to your normal activities within a day or two.

What Are the Risks?

Major complications are rare, however, as with many other procedures, there is a small risk of infection and bleeding. Depending on the method that was used, there is also a risk of burns to the vagina, vulva, and bowel, however, Kho notes that this risk is very low.

There is also a small risk of the device used possibly passing through the uterine wall or bowel during the procedure.

About, 20 percent of women require some kind of repeat treatment afterward, such as another ablation or a hysterectomy. The reason for these additional treatments typically is that uterine tissue was not completely destroyed during surgery, causing regrowth. In general, women who are younger than 45 years old at the time of ablation are more likely to need additional treatment such as a hysterectomy in the future due to this regrowth.

What Will Life Look Like After Recovery?

It may take several months before you experience the full effects of the ablation, but over time you should see a reduction, and possibly a complete cessation, of your menstrual bleeding.

If you are pre- or peri-menopausal, Kho recommends that you should still rely on a dependable form of birth control, not only to prevent unintended pregnancy but to also protect from sexually transmitted infections (when using certain types of birth control.)

While all medical procedures come with some risks, Kho stresses that the benefits typically outweigh the possible risks for many women.

“Many women are at their wits’ end when they decide to have endometrial ablation. In fact, I’ve seen adult women who have experienced abnormal bleeding since they were 14,” Kho says. “I tell women who have exhausted nonsurgical treatments and are done having children that if bleeding interferes with their everyday life — preventing them from doing certain activities, being intimate, or wearing the clothes they want — they might want to consider endometrial ablation.”