Many of the newer methods of endometrial ablation can be performed in your doctor's office. But some types of endometrial ablation are performed in a hospital, especially if you will need general anesthesia.
The opening in your cervix needs to be dilated to allow for the passage of the instruments used in endometrial ablation. Dilation of your cervix can happen with medication or the sequential insertion of a series of rods that gradually increase in diameter.
Endometrial ablation procedures vary by the method used to destroy your endometrium. Options include:
- Electrosurgery. This method uses a slender scope to see into the uterus during the procedure. An instrument passed through the scope — for instance, a roller ball, spiked ball or wire loop — becomes hot and is used to carve furrows into the endometrium. Electrosurgery requires general anesthesia and generally takes 30 minutes or less to complete.
- Extreme cold. Cryoablation uses extreme cold to create two or three ice balls that freeze and destroy the endometrium. Real-time ultrasound allows the doctor to track the progress of the ice balls. Each freeze cycle takes up to 6 minutes to complete; the number of cycles needed depends on the size and shape of your uterus.
- Free-flowing hot fluid. Saline fluid heated to 176 to 194 F (80 to 90 C) is circulated within the uterus for about 10 minutes. This method can be more painful than other office-based methods, but it's the method most likely to get complete coverage.
- Heated balloon. A balloon device is inserted through your cervix and then inflated with fluid heated to 188.6 F (87 C). The balloon helps prevent fluid from escaping up the fallopian tubes, but the balloon sometimes isn't flexible enough to contact the entire endometrium. This method takes about 10 minutes to complete.
- Microwave. In this method, the doctor inserts a slender wand that emits microwaves, which elevate the temperature of the endometrial tissue to 167 to 185 F (75 to 85 C). The doctor moves the wand from side to side while pulling it out of the uterus. Total treatment time is usually three to five minutes.
- Radiofrequency. A more automated method of endometrial ablation uses an instrument that unfurls a mesh electrode array within the uterus. The mesh transmits radiofrequency energy that vaporizes the endometrial tissue within 80 to 90 seconds.
After the procedure
After endometrial ablation, you may experience:
- Cramps. You may have menstrual-like cramps for a few days. Over-the-counter medications such as ibuprofen or acetaminophen can help relieve cramping after the procedure.
- Vaginal discharge. A watery discharge, mixed with blood, may occur for a few weeks. The discharge is typically heaviest for the first few days after the procedure.
- Frequent urination. You may need to pass urine more often during the first 24 hours after endometrial ablation.
You may need to avoid intercourse and tampon use for a period of time after the procedure. Ask your doctor how long you should wait before resuming these activities.
Oct. 11, 2012
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