Heavy periods are more than an inconvenience. In the video above, gynecologist Dr. Maryann Prewitt describes what many women deal with: excessive pain and bleeding, time off work and embarrassing situations. She explains how endometrial ablation can help without a major operation.
This article explains what the procedure is, who it’s for, what to expect and the questions to ask.
What endometrial ablation is
The endometrium is the lining of the uterus. Endometrial ablation destroys that lining to reduce menstrual bleeding. According to Mayo Clinic, the goal is to reduce how much you bleed during periods, and in some people the flow stops completely.
No cuts are needed. Slender tools are passed through the vagina and the cervix into the uterus. Depending on the method, the lining is treated with extreme cold, heated fluid, microwave energy or radiofrequency energy.
Dr. Prewitt uses a kitchen comparison to explain what happens: it’s like putting an egg white in a frying pan and watching the clear liquid turn white. That change is the protein coagulating, and she says the same thing happens to the lining of the uterus during the procedure.
Who it’s for
Mayo Clinic describes endometrial ablation as a treatment for very heavy menstrual blood loss, such as:
- periods heavy enough to soak a pad or tampon every two hours or less
- bleeding that lasts longer than eight days
- anemia (a low red blood cell count) caused by heavy bleeding
Other options are usually considered too, such as birth control pills or an intrauterine device (IUD).
Endometrial ablation generally isn’t recommended after menopause, or for women who have certain conditions of the uterus, cancer of the uterus or a higher risk of it, an active pelvic infection, or who want to become pregnant in the future.
Pregnancy after ablation
This is one of the most important points to understand. Endometrial ablation is not a form of sterilization. According to Mayo Clinic, it’s still possible to get pregnant afterward, but the pregnancy is high risk for both mother and baby and may end in miscarriage. Long-lasting or permanent birth control is advised after the procedure.
Hormones
Dr. Prewitt explains that endometrial ablation has no effect on a woman’s hormones, so there’s no need for medicines to replace them.
Before the procedure
In the weeks before, Mayo Clinic says your health care provider will typically:
- check that you aren’t pregnant
- take a small sample of the uterine lining to test for cancer
- examine the uterus with ultrasound, and sometimes with a lighted scope (hysteroscopy)
- remove an IUD if you have one
- sometimes thin the lining with medicine or a D&C first
You’ll also talk about anesthesia. Ablation can often be done with sedation, pain medicine and numbing injections, but sometimes general anesthesia is used. In the video, Dr. Prewitt describes the procedure being done while the patient is asleep. It can take place in a doctor’s office or in an operating room.
Recovery
Dr. Prewitt describes endometrial ablation as a minor outpatient procedure that allows a woman to avoid major surgery and return to work the next day. MedlinePlus, from the National Library of Medicine, says you can return to normal daily activities within 1 to 2 days, and advises not having sex until your provider says it’s OK.
Afterward, Mayo Clinic says you may have:
- period-like cramps for a few days, which nonprescription pain relievers can help with
- a watery discharge mixed with blood for a few weeks, heaviest in the first few days
- a need to urinate more often in the first 24 hours
Ask your provider when you can exercise and have sex again.
Results
According to Mayo Clinic, it can take a few months to see the final results. Ablation often reduces bleeding: periods may become lighter or stop entirely.
In the video, Dr. Prewitt says women are very satisfied to be able to keep their uterus while no longer having to deal with menstrual problems or irregular periods.
Risks
Mayo Clinic says complications are rare and can include:
- pain, bleeding or infection
- heat or cold damage to nearby organs
- a puncture of the wall of the uterus from the instruments
Questions to ask your doctor
- What’s causing my heavy bleeding, and which tests do I need first?
- Which other treatments could I try, such as birth control pills or an IUD?
- Is ablation a good choice for me, given my age, health and plans for children?
- Which ablation method would you use, and why?
- Will it be done in the office or the operating room, and what anesthesia will I have?
- What birth control should I use afterward?
- How much lighter can I expect my periods to be, and when will I know?
- When can I go back to work, exercise and sex?
Dr. Prewitt is a gynecologist in the Dallas-Fort Worth area. See her Best Docs Network profile for more about her practice.
This article is for general information only and is not medical advice. Talk with a qualified health professional about your own situation. If you think you may have a medical emergency, call 911.
