What is endometrial ablation?
In endometrial ablation, the mucous membrane of the uterus is sclerosed down to the muscles of the uterine wall using very high heat. In the process, the treated tissue dies. In rare cases, strong cold is used instead of great heat.
The procedure counteracts a renewed build-up of the mucous membrane in the monthly cycle and thus reduces menstruation to a normal level or even prevents it altogether.
Endometrial ablation is the alternative to surgical removal of the uterus (hysterectomy) with fewer complications. A distinction is made between first and second generation procedures:
First generation procedures
- Resection with the resection loop: Electricity is passed through a wire loop and heats it up so that the mucosa of the uterus can be sclerosed with it.
- Laser ablation by an ND:YAG laser: lasers obliterate the mucosa.
Second generation procedure
- Hydrothermablation: fluid is pumped into the uterus where it is strongly heated.
- Bipolar mesh (NovaSure, gold mesh method): A thin gold mesh is stretched inside the uterus and heated strongly.
- Microwave ablation (Microwave): Microwave energy is delivered to the uterine lining through a probe.
When do you perform an endometrial ablation?
Endometrial ablation is performed in the following cases:
- in cases of bleeding disorders that are difficult to treat, such as excessive menstruation with normal or prolonged bleeding (hypermenorrhea or menorrhagia)
- in case of bleeding disorders under continuous anticoagulant therapy
- as an alternative to surgical removal of the uterus (hysterectomy)
Endometrial ablation is only performed when family planning has been completed, as the rate of malformations in newborns is significantly increased afterwards.
Endometrial ablation is not used for malignant changes in the uterus (carcinomas) or precancerous lesions.
What is done during endometrial ablation?
Every endometrial ablation is preceded by a scraping with a fine-tissue examination in the laboratory for fibroids, polyps or precursors of malignant changes. Hormone administration (GnRH = gonadotropin releasing hormone) before the operation thins out the uterine lining. This can shorten the duration of the operation and improve the result.
First generation procedure
The most common method in endometrial ablation is the combination of snare resection and roller ball coagulation (first generation procedure). In this procedure, the surgeon first removes the larger areas of the anterior, posterior and lateral walls of the uterus with the snare, and then uses the roller ball to obliterate the mucosa in the overlying part (fundus uteri) and in the corners of the fallopian tubes (tube).
Second generation procedure
In the uterine balloon method, a folded plastic balloon is inserted into the uterine cavity and inflated with hot fluid. The intense heat causes the uterine lining to die within a few minutes.
What are the risks of ablation?
In addition to the general risks of surgery, such as infection, there is also the possibility of specific complications. However, because endometrial ablation is a gentle procedure, these are rare. They include:
- Perforation of the uterine wall
- Wound healing problems
- Post-endometrial ablation syndrome (bleeding or congestion of blood in the uterus)
- Injury to neighboring organs
What do I have to consider after an endometrial ablation?
You will usually be discharged several hours – rarely days – after the procedure. Beforehand, you will be thoroughly examined and have a final discussion about further measures with your attending physician.
In the first few days after the operation, there may sometimes be bleeding from the wound and a brownish discharge. For three weeks you should refrain from swimming, bathing, sexual intercourse, tampons and visits to the sauna, as the cervix is still slightly open.
In order to be able to assess the success of the treatment, it is advisable to have several check-ups – the doctor treating you will tell you at what intervals.
