Endometrial Ablation – The Pros and Cons

by Marcelle Pick, OB/GYN NP

There are times that medical terms can be a little intimidating to people who aren’t familiar with what they mean. Some of you might know what something means in a general way, but it’s always best to know, for your own well-being and peace of mind, specifically what something means. This will better help you know what’s going on with your body and also help you make the best decision about what’s right for you.

The procedure called endometrial ablation might be a great option for you to consider rather than having a hysterectomy, after you have tried other less invasive measures. For example, if you are seeking an option that would allow you to keep your uterus, especially if you have tried hormonal management and it did not work, then ablation may well be a good choice.

Here is more information about this procedure. Ablation means “to remove by erosion, melting, evaporation, or vaporization.” Endometrial ablation is done with a hysteroscope, along with a device that heats, freezes, or lasers your endometrial lining. This destroys a layer of your endometrial lining, and usually your monthly menstrual period will stop completely—at least for a while—and usually you will not be able to become pregnant following uterine ablation. However, it’s a good idea to remember that there are women who do get pregnant after this procedure, so it’s very important that birth control or sterilization be reviewed, as post-ablation pregnancies can be risky. Some insurance companies require that a woman be sterilized before they’ll pay for the ablation procedure.

Some types of this procedure can be performed by a trained gynecologist (GYN) in the office. It can be done fairly quickly and easily. This can be useful to treat selected areas of the endometrial lining. In other circumstances, it needs to be done under anesthesia after a hysteroscopically–guided dilatation and curettage (D&C) sampling. This may be an ideal way to exclude pathology, rather than assuming that an endometrial biopsy is adequate.

At Women to Women we don’t recommend this course of action as a first line intervention for several reasons. For one, we always try to suggest the most minimally invasive procedures and recommend medical management when possible. In addition, we generally obtain a good outcome with medical management of our patients who have heavy bleeding. Although endometrial ablation does work well for some women, the long-term results for treating heavy bleeding with endometrial ablation are not always predictable, and there is a relatively high rate of recurrence. Our nurses have heard from women who have had an ablation that it had failed and that their heavy periods returned after a year or two. Another issue is that there is a risk that endometrial ablation might mask endometrial cancer later in life, because it removes any endometrial spotting that would signal to you that something abnormal is happening in your body.

Now that you know more about this process, you can do what you think and feel is best for your healthy lifestyle. To sum it up, endometrial ablation has its limits. With time we can look forward to medical technology that will bring us more advanced treatment alternatives to hysterectomy. But until then, ablation techniques do offer women and their healthcare practitioners some options that can be useful in certain circumstances.