Thinking about endometrial ablation? Find out more. ENDOMETRIAL ABLATION BACKGROUND Until the last few years, the only surgical treatment for heavy of excessive menstrual bleeding was hysterectomy (which is the surgical removal of the uterus). However, now another treatment option is available. Endometrial ablation is the surgical procedure that destroys the lining of the uterus, also called the endometrium, which in many cases will decrease or even completely stop the menstrual bleeding. The rationale behind the surgery is to remove the source of the bleeding, the endometrium, without having to remove the uterus. This is not dangerous and does not cause menopause. The first question that needs to be addressed is why a woman is having abnormal bleeding and what are all of the treatment options available? There are several reasons why a woman has heavy bleeding and they should be evaluated prior to surgical treatment. The most serious reason is cancer of the lining of the uterus (endometrial cancer). Fortunately, this can usually be diagnosed with a simple office biopsy. Other important causes of bleeding include fibroids, endometrial polyps and hormonal causes. Several different tests may be used to help determine the cause of the bleeding and its severity. Ultrasound can be very helpful to determine if there are any structural abnormalities of the uterus, such as fibroids or polyps. Endometrial biopsy can be used to exclude cancer and also may help find polyps. Also, a blood count can be used to determine if the amount of bleeding is so excessive as to cause anemia. Once the cause of bleeding has been identified, a treatment plan can then be devised. Many times this includes various hormonal treatments. However, some patients cannot tolerate these therapies and elect to have surgical treatment. The two surgical treatments that can be offered are hysterectomy and endometrial ablation. Endometrial ablation is performed in conjunction with hysteroscopy. A fiberoptic rod is inserted through the cervix and the entire uterine cavity can be visualized. Then a specialized instrument is inserted and electrical, thermal or laser energy is applied and the lining of the uterus is destroyed. Other abnormalities of the uterus can also be treated at the same time. Fibroids and polyps can also be easily removed. This is a surgical procedure very similar to a D&C, and is done as an outpatient, same day surgical procedure. RISKS AND BENEFITS “First do no harm.” Every surgery that is performed has risks. Endometrial ablation is no different. The main risks associated with the surgery are the same as those of any other surgery, namely bleeding and infections. Either one of these can require hospitalization and more surgery, usually a hysterectomy. Also, sometimes when the cervix is being dilated to allow the hysteroscope to be inserted, a hole is made in the uterus. This is called uterine perforation. Usually this is not a major problem but it makes completing the planned surgery difficult. Sometimes, perforation occurs during the application of electrical energy to the uterus. If this happens, then the bowels or bladder may be injured which will require further surgery to fix the complication. Another rare complication is fluid overload. Fluid is used to distend the uterus so that the endometrial cavity can be viewed. Sometimes too much fluid is adsorbed by the body. If this is starting to happen then the surgery is stopped, often before it is completed, to prevent any harmful effects. If the surgery continues and the fluid continues to be adsorbed, then the fluid can cause dangerous swelling of the lungs, brain and heart. The main benefit of the surgery is the end of menstruation. More than 80% of patients who have this surgical procedure will have anywhere from no menstrual cycle to a normal cycle. This does not cause any harm to the body and does not cause menopause. No hormones are needed, the ovaries will continue to function as usual. To summarize, endometrial ablation is a surgical procedure similar to D&C that can stop heavy menstrual bleeding and thus prevent a hysterectomy.