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Endometrial Ablation

Endometrial Ablation and Fertility

by GP
Endometrial Ablation

What is Endometrial ablation?

An Endometrial ablation is a procedure that surgically destroys (ablates) the lining of your uterus (endometrium). The goal of endometrial ablation is to stop excessive bleeding your doctor might consider it if you bleed between your menstrual periods, have a heavy flow, or have periods that last a long time. If medicine doesn’t help, your doctor might suggest endometrial ablation. It can curb the bleeding or stop it.

Heavy menstrual bleeding can have many causes. Changing hormones might be the reason. Or it could be fibroids and polyps growing in your uterus.

Endometrial ablation removes the endometrium, which is the lining of the uterus. In most cases, your period will return to normal or light flow, although it sometimes will stop completely.

Endometrial ablation can put an end to heavy bleeding that gets in the way of your everyday life (maybe you need to change your tampon or pad every hour, or you bleed for more than a week). If your bleeding causes other health problems, like anemia, this procedure could also help.

Still, endometrial ablation isn’t right for everyone. If you’re post-menopausal, you shouldn’t have it done. It’s also not recommended if you have:

Uterine, cervical, or endometrial cancer

Pelvic inflammatory disease (PID)

A vaginal or cervical infection

A weak wall to your uterus

An infection of the uterus

A scar from a Caesarean section

An intrauterine device (IUD)

A disorder of the uterus or endometrium

You also shouldn’t have endometrial ablation if you’re pregnant or want a baby in the future. Discuss contraception with your doctor. Endometrial ablation isn’t meant to be a sterilization procedure, but it usually is. Although your reproductive organs remain intact, conception and successful pregnancy afterward are unlikely.

If you’re planning to have children, you should choose to wait to have this procedure. You should discuss your reproductive options with an infertility specialist before having the procedure.

Your healthcare provider can test your egg quality and quantity through an anti-Müllerian hormone (AMH) or follicle-stimulating hormone (FSH) blood test. If your eggs are of good quality, you can opt to freeze your eggs or fertilize embryos before the procedure.

Although it isn’t guaranteed that frozen eggs or embryos will result in pregnancy, having them may provide this option later on. A surrogate might carry the pregnancy for you.

If freezing your eggs or embryos isn’t an option, you may decide to use an egg donor and a surrogate to conceive. If you can choose to delay the procedure until you have children, you might want to do so. Adoption is also a consideration.

Weighing these options, as well as the need for the procedure, may feel overwhelming. Talking to your healthcare provider about your feelings may be beneficial. They can recommend a counselor or therapist to help you process and support you.

Preparation of Endometrial ablation

A few days before the Endometrial ablation some requirements need to be fulfilled such as;

Perform a pregnancy check. Endometrial ablation can’t be done if you’re pregnant.

Check for cancer. A thin tube (catheter) is inserted through your cervix to obtain a small sample of your endometrium to be tested for cancer.

⦁ Remove an IUD. Endometrial ablation isn’t performed with an IUD in place.

⦁ Thin your endometrium. Some types of endometrial ablation are more successful when the uterine lining is thin. Your doctor might prescribe medications or perform a dilation and curettage (D&C), a procedure in which the doctor scrapes out the extra tissue.

⦁ Discuss anesthesia options. Some methods of endometrial ablation require general anesthesia, so you’re asleep during the procedure. Other types of endometrial ablation might be performed with conscious sedation or with numbing shots into your cervix and uterus.

⦁ Plan for someone to pick you up afterward.

⦁ Depending on the type of endometrial ablation, you may take medicine that thins your uterus lining.

⦁ Plan to fast (no food or drink) 8 hours before the procedure.

Endometrial ablation procedure

Endometrial ablation may be done in the office or the operating room. You’ll be given a gown and an IV. You’ll situate yourself on a table as if you’re having a pelvic exam. You may be given medicine about an hour before the endometrial ablation to help manage any discomfort after the procedure. Depending on the type of endometrial ablation, your provider may numb your pelvic area and give you sedatives so that you don’t feel any pain or discomfort during the procedure.

During endometrial ablation, your healthcare provider inserts a delicate, wand-like device into your vagina. This device extends through your cervix and into your uterus, where it can reach the lining. Depending on the type of endometrial ablation, the device sends energy, heat, or cold to destroy part of the lining. The technology makes things quick and you should have minimal or no discomfort during the procedure. There different  methods or procedures of Endometrial ablation such as

⦁ Cryoablation: Extreme cold is used to create two or three ice balls that freeze and destroy the endometrium. Real-time ultrasound allows the doctor to track the progress of the ice balls. Each freeze cycle takes up to six minutes, and the number of cycles needed depends on the size and shape of your uterus.

⦁ Electrosurgery: A small, tube-like device with a viewing lens (resectoscope) is fitted with a wire loop, rollerball, or laser that releases electricity. The electricity destroys parts of your uterus lining. The viewing lens helps your provider see inside your uterus and monitor the electrical currents as they turn parts of the lining into scar tissue. This type of ablation is the least common and may require you to have anesthesia. You’ll probably need to go to a hospital for electrosurgery.

⦁ Heated balloon: A balloon device is inserted through your cervix and then inflated with heated fluid. Depending on the type of balloon device, the procedure can take from two to 10 minutes.

⦁ Radio waves (radiofrequency): A wand-like instrument with a mesh tip unfurls inside your uterus, just enough so that radio waves can reach the lining. The mesh releases radio waves that heat and destroy parts of the lining. The process takes from one to two minutes.

⦁ Microwave: A slender wand is inserted through the cervix. The wand emits microwaves, which heat the endometrial tissue. Treatment usually lasts three to five minutes.

⦁ Heated fluid (hydrothermal): A thin, flexible tube with a viewing lens that lets the doctor see inside your body (hysteroscope) moves room-temperature saline into your uterus. Once inside, the saline is heated to a temperature hot enough to destroy the lining. The process takes about 10 minutes. This kind of ablation works well for uteruses that have an irregular shape.

After Endometrial ablation  Pay close attention to your body. You’ll probably notice some changes after you’ve had the endometrial ablation. They’re normal, so there’s no need to worry.

You may feel a little nauseous.

You may have to pee more the first day after the procedure.

You may have period-like cramps for one to three days after endometrial ablation.

You may have light bleeding or pink discharge for a few weeks after. It’s usually heaviest on Day 2 and Day 3 after you’ve had the procedure. You’re bleeding the uterus lining that was destroyed so that you don’t have a heavy period later.

Give yourself time to heal. Don’t douche or use a tampon the first 3 days after you’ve had the procedure.

Risks and complications

Women are advised to continue using birth control after having an endometrial ablation. If pregnancy does occur, it’s more likely to result in miscarriage.

Normally, the endometrial lining thickens in response to pregnancy. Without a thick endometrial lining, an embryo can’t implant and grow successfully. For this reason, your healthcare provider may recommend sterilization as an additional procedure.

Apart from the very real risk to your fertility, complications from this procedure are rare, according to the Mayo Clinic.

These rare risks can include:

puncturing of your uterine wall or bowels

infection or bleeding after your procedure

damage to your vagina, vulva, or bowels from the hot or cold applications used during the procedure

absorption of the fluid used during the procedure into your bloodstream late-onset endometrial ablation failure Trusted Source, a condition where the endometrium grows back abnormally after the procedure.

Outlook of Endometrial ablation

Recovery may last anywhere from a few days to a few weeks. During this time, make sure to treat yourself with care. Talk to your healthcare provider about when you can expect to resume daily activities, as well as more strenuous exercise and sexual intercourse.

After the procedure, your periods should lighten or stop completely within a few months.

If you didn’t undergo sterilization and you’ve chosen to practice sex with birth control, you should continue to use your preferred method. Birth control can help prevent pregnancy and its potential complications.

While it’s unlikely that you’ll be able to conceive and carry a child full term, a pregnancy can still happen.

It’s also still important to practice sex with a condom or other barrier method to prevent the transmission of sexually transmitted infections (STIs).

Endometrial ablation and Fertility 

Pregnancy can occur after endometrial ablation. However, these pregnancies might be higher risk to mother and baby. The pregnancy might end in miscarriage because the lining of the uterus has been damaged, or the pregnancy might occur in the fallopian tubes or cervix instead of the uterus (ectopic pregnancy).

Some types of sterilization procedures can be done at the time of endometrial ablation. If you are having endometrial ablation, long-lasting contraception or sterilization is recommended to prevent pregnancy.

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