Endometrial ablation is a procedure that surgically “ablates” or destroys the lining of your uterus (your endometrium). Your uterus is a pear-shaped organ tucked inside your pelvis. It is about 7.5 cm long and 5 cm wide. Your uterus is hollow inside and has thick muscular walls.
What Is Your Endometrium?
Your endometrium is the mucous membrane that lines the inside of your uterus. Your endometrium thickens during your menstrual cycle, in preparation for an embryo to be possibly implanted in your uterus.
Endometrial ablation is the standard treatment for excessive loss of menstrual blood. Patients who seek endometrial ablation experience the following:
- Anemia (a deficiency of red blood cells or hemoglobin in the blood) from excessive blood loss. Anemia produces symptoms of weariness and pallor (pale sickliness).
- Bleeding (menstrual) that lasts longer than eight days and is not responding to other treatments.
- Childbearing is completed. If you are sure that you don’t want to have another child, you can start considering endometrial ablation surgery as an option. Pregnancy is possible after your endometrial ablation, but it is a dangerous situation for you and your baby.
- Hysterectomy (the removal of your uterus) is not preferred or not possible due to other medical issues. Having a hysterectomy can stop your excess menstrual bleeding from happening. But if you have other serious medical issues of malformation in your pelvic region, endometrial ablation is the logical option.
- Unusually heavy periods that completely soak a pad or tampon in two hours or less.
The goal of an endometrial ablation is to reduce your menstrual flow, sometimes even stopping it completely. Endometrial ablation is not recommended for women who are postmenopausal or women who are experiencing abnormalities of the uterus:
- Arcuate Uterus: This uterus looks relatively normal, except there is a slight indentation at the top of it.
- Septate Uterus: Where the inside of your uterus is divided by a muscular wall called the septum.
- Unicornuate Uterus: This uterus only has one fallopian tube, and it is half the size of a normal uterus. Your uterus looks like a horn and goes off to one side. You will still have two ovaries although only one will be attached to a fallopian tube.
- Uterus Didelphys: A “double” uterus. When your uterus has two inner cavities where each may lead to its own cervix and vagina.
Cancerous uterine abnormalities include:
- Cancer of the Uterus: The two main types of cancer of the uterus are uterine sarcomas and endometrial carcinomas.
- Endometrial Carcinomas: A carcinoma is a cancer arising in the skin, epithelial tissue, or lining of your organs. Endometrial carcinomas start in the cells of the inner lining of your uterus, also known as your endometrium.
- Uterine Sarcomas: A sarcoma is a malignant tumor of connective tissue. Uterine sarcoma occurs in the muscle layer (myometrium) that forms the supportive connective tissue inside your uterus.
Inflammatory infections that pose a problem to the procedure:
- Pelvic Infection: Also known as pelvic inflammatory disease, PID develops as the result of sexually transmitted diseases. Most PID cases result from an untreated infection caused by either gonorrhea or chlamydia. However, it is also possible that a large range of bacteria being present in the uterus could be responsible.
Endometrial Ablation Preparation
Preparing for an endometrial ablation involves talking with your doctor, making decisions about your treatment and taking care of concerns that need to be addressed before you are operated on. The five things your doctor will do to make sure you are ready for surgery:
- Discuss Anesthesia Options
- Cancer Check
- Endometrium Thinning
- IUD Removal
- Pregnancy Check
What are the risks of getting an endometrial ablation? The risks involved in endometrial ablation are rare and include:
- Buildup of Fluid in the Lungs (Pulmonary Edema)
- Burns to the Uterus or Surface of the Bowel
- Cervical Laceration
- Heat or Cold Damage to Organs Nearby
- Pulmonary Embolism
- Puncture Injury: Your surgeon may accidentally damage the uterine wall with his or her surgical instruments.
Post-Op Endometrial Ablation
After endometrial ablation, pregnancy can occur. However, these pregnancies may pose a higher risk for you and your baby. Because the lining of your uterus has been damaged, your pregnancy may end in a miscarriage. Or you may suffer from a painful ectopic pregnancy, where your pregnancy occurs not in the uterus but the fallopian tubes or cervix. This procedure should never be given if you may desire pregnancy in the future.
Your doctor will typically try to combat your excessive menstrual bleeding by prescribing medications or an intrauterine device that can help you regulate your menstrual cycles. Endometrial ablation becomes an option if these other treatments don’t assist your excess bleeding, or if you are unable to have these other therapies done.
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