Endometrial Ablation to Halt the Hemorrhage

If you’ve seen an advertisement for uterine ablation, the process that destroys the lining of the uterus to eliminate periods, you’d imagine that every woman who has had this procedure spends her time dressed all in white, happily walking, dancing or riding her bike on the beach. Clearly those who have been suffering from heavy bleeding are highly motivated to get back into their white clothes and spend a day in the sun. As tempting as it is to jump on the ablation bandwagon, there are a number of things to consider before booking the procedure.


Endometrial ablation works by putting a tissue-destroying device into the uterine cavity through the cervical opening. I perform ablation in my office in less than 15 minutes and my patients generally return to work the next day. But endometrial ablation is not for everyone. Women who desire pregnancy obviously should not destroy the lining of their uterus. For women with large fibroids, adenomyosis, or an irregularly shaped uterine cavity, the treatment is often ineffective. An ablation should never be performed if there is cancer, pre-cancer or a high risk of uterine cancer. If there is any question as to the cause of the bleeding, the treatment should not be done.


In appropriate patients (that’s the key), data shows that 60- 90% of women who undergo the procedure are very pleased they had the procedure since they never bleed again or end up with ridiculously light periods. 


So what’s the down side? Complications are rare, but like any surgical procedure, they can occur. Some women undergo ablation only to fail and then require another procedure, such as hysterectomy, to solve their problem. One concern on the part of gynecologists is potential long-term issues after a woman undergoes ablation. If a woman who has undergone endometrial ablation develops abnormal bleeding, the usual ways to evaluate this bleeding, such as ultrasound and endometrial biopsy, are not as reliable. 


And, while endometrial ablation doesn’t increase the risk of uterine cancer (which strikes approximately 32,000 women each year), it might make early detection more difficult if women develop cancer years after the procedure, leading to a worse prognosis. Uterine cancer is usually diagnosed at an early stage – and then is almost always curable – due to the presence of abnormal uterine bleeding, which might be eradicated by the procedure.


As I work on a second edition of my book, The Essential Guide to Hysterectomy (2004), in which I discuss the pros and cons of ablation, I’ve noticed a striking increase in the number of women who are choosing this procedure. The question then was, has this increase in endometrial ablation led to less hysterectomies?


While the original hope was that this minimally invasive procedure would decrease the necessity for removing the uterus, the number of hysterectomies performed has barely budged despite the dramatic increase in ablation procedures.


This is because the majority of women who have ablations fall into two categories. Group one are women who hate their heavy periods and are thrilled to have an ablation to eliminate or reduce bleeding, but never would have considered a hysterectomy if ablation had not been an option. Group two are women who have large fibroids or adenomyosis who have an ablation in hopes of avoiding a hysterectomy; often, the procedure fails because they were not a good candidate in the first place. They continue to have heavy bleeding and ultimately end up with a hysterectomy.


The bottom line is that if you have a monthly period that rivals Niagara Falls, ablation may be a life-changing ideal solution. But for some women, this is a procedure that only delays the inevitable.


Added to Women's Health, Anatomy, Gynecology on Sat 12/10/2011