Endometrial ablation is the surgical removal of the endometrium or the lining of the uterus. The uterus is a pear-shaped organ located in the lower abdominal (pelvic) area where a baby grows during pregnancy. When pregnancy does not occur, the endometrium is shed each month through menstrual bleeding. Endometrial ablation is a treatment for menorrhagia (abnormally heavy menstrual bleeding). Endometrial ablation is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having endometrial ablation. Types of endometrial ablation The types of endometrial ablation procedures include: Balloon thermal ablation involves inserting a balloon into your uterus and filling it with heated liquid. The heat destroys your endometrium after approximately 10 minutes. Cryoablation or freezing involves inserting a small probe into your uterus. The tip of the probe cools to extremely low temperatures. It freezes your endometrium to destroy it. Electrosurgery involves inserting a special tool into your uterus that carries an electrical current. The electrical current destroys your endometrium. The tool can have a rollerball, wire loop, spiked ball, or triangular mesh tip. You will have this procedure done with general anesthesia in a hospital. Hydrothermal ablation involves instilling and circulating heated fluid, usually saline, inside your uterus. The heat destroys your endometrium after approximately 10 minutes. Laser involves inserting a laser probe into your uterus. The laser light energy destroys your endometrium. Microwave involves inserting a probe into your uterus that uses microwave energy to destroy your endometrium. Radiofrequency involves inserting a probe into your uterus that uses radio wave energy to destroy your endometrium. Your doctor may recommend endometrial ablation to treat menorrhagia, which is abnormally heavy menstrual bleeding. Your doctor may only consider endometrial ablation for you if other treatment options with less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on endometrial ablation. Endometrial ablation is an alternative to more invasive procedures, such as a hysterectomy. A hysterectomy is the surgical removal of a woman’s uterus. Some women should not have a endometrial ablation. This includes women with the following conditions: Being past menopause Current or recent infection of the uterus Desire to bear a child in the future Disorders of the uterus or endometrium Noncancerous or precancerous uterine growths Pregnancy or recent pregnancy Uterine cancer Uterine fibroids An obstetrician-gynecologist performs endometrial ablation. An obstetrician-gynecologist is a doctor who specializes in the medical and surgical treatment of the female reproductive system. Your endometrial ablation will be performed in a hospital, outpatient surgery center, or office setting. Surgical approaches to endometrial ablation Endometrial ablation does not involve incisions or cutting. It may be performed using one of the following approaches: Hysteroscopic procedures involve inserting special instruments and a hysteroscope into your vagina, through your cervix (opening to the uterus), and into your uterus. A hysteroscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your body to a video screen viewed by your doctor while performing surgery. Nonhysteroscopic procedures involve inserting specialized probes into your vagina, through your cervix, and into your uterus. Your doctor may use ultrasound imaging to view the probe’s position inside your uterus. Your doctor will advise you on which procedure is best for you and how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different procedures and ask why your doctor/surgeon will use a particular type of procedure for you. Types of anesthesia that may be used Your surgeon will perform endometrial ablation using local or general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. General anesthesia is typically used for the type of endometrial ablation procedure called electrosurgery. Local anesthesia involves injecting an anesthetic medication around certain nerves so you do not feel anything in the area. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable. What to expect the day of your endometrial ablation The day of your surgery, you can generally expect to: Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form. Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth. Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive. A surgical team member will start an IV. The anesthesiologist or nurse anesthetist will start your anesthesia. A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen. The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable. As with all surgeries, endometrial ablation involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery. General risks of surgery The general risks of surgery include: Anesthesia reaction, such as an allergic reaction and problems with breathing Bleeding, which can lead to shock Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis Infection Potential complications of endometrial ablation Complications of endometrial ablation include: Burns to your vagina, vulva or bowels Damage to your bladder, bowels, or blood vessels Electrolyte imbalance (too much or too little salts in your body) from the fluid used in electrosurgery Perforation or puncture of your uterus or bowels Return of menorrhagia after several years. Hysterectomy may be recommended should this occur. Reducing your risk of complications You can reduce the risk of certain complications by following your treatment plan and: Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, redness, swelling, or drainage Taking your medications exactly as directed Telling all members of your care team if you have any allergies You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare yourself for endometrial ablation by: Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times. Getting preoperative testing as directed. Preoperative testing may include an endometrial biopsy, hysteroscopy (to view the inside of your uterus), ultrasound imaging, pregnancy test, and other tests as needed. If you have an intrauterine device (IUD), you will need to have it removed before your endometrial ablation. Losing excess weight before the surgery through a healthy diet and exercise plan. Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia. Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process. Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor may also give you medications to thin your endometrial lining and make it easier to insert the surgical devices. Questions to ask your doctor Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments. It is also a good idea to bring a list of questions to your appointments. Questions can include: Why do I need endometrial ablation? Are there any other options for treating my condition? Which type of endometrial ablation procedure will I need? How long will the surgery take? When will I go home? What restrictions will I have after the surgery? When can I return to work and other activities? What kind of assistance will I need at home? How should I take my medications? How will you treat my pain? When should I follow up with you? How should I contact you? Ask for numbers to call during and after regular hours. Knowing what to expect can help make your road to recovery after endometrial ablation as smooth as possible. How long will it take to recover? You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable. You will go home on the same day if you are recovering well. A hospital stay is rarely required for endometrial ablation. Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Most women return to their usual activities within a day or two, but it can take several months to see the full effects of endometrial ablation. Will I feel pain? Pain control is important for healing and a smooth recovery. The nerves inside your uterus cannot feel heat, cold, or electrical stimulation, so the procedure itself is usually painless. You may have discomfort for several days after your surgery, including cramping, nausea, frequent urination, and a watery, bloody discharge. Your doctor will treat your pain and nausea so you are comfortable and can get the rest you need. Call your doctor if discomfort gets worse or changes because it may be a sign of a complication. When should I call my doctor? It is important to keep your follow-up appointments after endometrial ablation. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have: Bloating, swelling or pain in your abdomen or belly Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion Chest pain Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever. Heavy vaginal bleeding Inability to urinate, pas gas, or have a bowel movement Pain Vomiting How might endometrial ablation affect my everyday life? Endometrial ablation may cure your condition or significantly reduce your symptoms so you can lead an active, normal life. Endometrial ablation can also cause significant changes to your body that may affect your everyday life, such as: Continued need for routine screenings including PAP smears and pelvic exams, because you still have a uterus and cervix Increased risk of miscarriage should pregnancy occur. Women who still desire to have children should not have endometrial ablation. Need for birth control. While pregnancy after endometrial ablation is not likely, it is possible because you still have a uterus. Pregnancy after endometrial ablation is extremely risky.