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Endometrial Ablation

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Ablation is the medical terminology for “Surgical removal of a body part or tissue” and here we are dealing with excision of the uterus lining which is known as endometrium. It’s a non invasive surgical technique aimed at controlling abnormal uterine bleeding.

Why is it done?

Some women experience abnormal bleeding during menstruation, which is not at all conducive for the body. Thus, ablation is performed for the following reasons:

  • To prevent anaemia due to unusual blood loss
  • It’s done if other hormonal and medical treatments to control heavy periods have failed
  • When you either don’t want to have a hysterectomy or your health condition doesn’t permit hysterectomy

On whom it is not recommended?

  • Pregnant women
  • Recently delivered a baby
  • Menopausal women
  • With uterus, cervical or endometrial cancer
  • Planning to have a baby anytime in the future
  • Suffering from infections in the genital tract
  • Previous uterine surgery for fibroids
  • With pelvic inflammatory disease

How to prepare for the test?

During the appointment, your doctor will check your blood pressure, measure your weight, analyse your medical record, ask various questions regarding your health, diet and lifestyle, and about the medications that you might be taking. He will give a nod only after he is assured that you are medically fit to undergo the ablation.

Then you need to prepare for the following:

  • Doctors perform endometrial sampling weeks before the surgery to check for presence of cancer. This pre biopsy is mandatory.
  • Secondly, hysteroscopy is done to check for uterine polyps and fibroids. If they are the cause of heavy flow, then they are removed.
  • Lastly, IUD devices are removed before the surgery.
  • Endometrial ablation becomes easier when the endometrium is thin and for this purpose hormonal therapy with gonadotropin-releasing hormone analogues may be carried out a priori.
  • After success of these steps, you are given anaesthesia which depends on the ablation technique used.

Different types of endometrial ablation techniques

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The cervical opening is first dilated either with instruments or medicines

  • Electrical or electrocautery- passing electric current with a rollerball or wire loop to ablate the endometrium
  • Hydrothermal – use of heated fluid for destroying the endometrium
  • Laser beam ablation - high-energy beam of light is used here
  • Radiofrequency ablation -   A probe or a thin wand is inserted into the uterus which sends energy waves to destroy the endometrium.
  • Microwave ablation – a microwave emitting probe is inserted in the womb
  • Cryoablation or freezing- a probe of very low temperature is used to freeze the endometrium
  • Balloon therapy- a flexible balloon is placed in the uterus which is then inflated with hot fluid to ablate the endometrium

What to expect after the procedure?

  • Day one of the procedure will be uncomfortable for you because you will undergo frequent urination. Symptoms of nausea and vomiting may also be there.
  • You experience pain and cramping in the pelvic region. Your doctor might prescribe you pain killers for relief.
  • The effect of anaesthesia will be there- you will feel drowsy. Avoid driving or joining office immediately.
  • Pinches of blood and watery vaginal discharge may continue for a week to few. Do not worry about that. However, do not use tampons.
  • Your doctor will ask you to take rest and refrain from sexual intercourse at least for 3-4 days. Also do not douche.

Risks associated with endometrial ablation

  • Perforation or injury to the uterus
  • Accidental heat burn or cold damage of nearby organs
  • Tearing of cervical opening
  • Build up of fluid into the bloodstream
  • Infections, bleeding and pain
  • Increases changes of miscarriages i.e. high risk pregnancy

The fina results may not show up immediately and might take a few months for considerable reduction in menstrual blood loss. However, under all circumstances you need to follow each and every advice and precaution suggested by your doctor to avoid risking your health.

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Written by: Saptakee sengupta
Date last updated: January 11, 2015

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