Menstrual Disorders - Surgery

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Types of Endometrial Ablation. Endometrial ablation used to be performed in an operating room using electrosurgery with a resectoscope (a hysteroscope with a heated wire loop or roller ball.) Laser ablation was another older procedure. These types of endometrial ablation have largely been replaced by newer types of procedure that do not use a resectoscope.

The newer procedures can be performed either in an operating room or a doctor’s office. They include:

• Radiofrequency. The NovaSure system uses a mesh electrode probe that emits electromagnetic energy to destroy the lining.
• Heated fluid. In the HydroThermAblator system, a saline solution is inserted into the uterus with a hysteroscope and heated until the lining is destroyed. In the thermal balloon method, a balloon inserted into the uterus with hysteroscope is filled with heated fluid and expanded until it touches and destroys the endometrium.
• Freezing. Cryoablation uses liquid nitrogen to freeze the uterine lining.
• Microwave. Microwave endometrial ablation applies very low-power microwaves to the uterus.

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Before the Procedure. In preparing for the ablation procedure, the doctor will perform an endometrial biopsy to make sure that cancer is not present. If the woman has an intrauterine device (IUD), it must be removed before the procedure. In some cases, hormonal drugs, such as GnRH analogs, may be given a few weeks before ablation to help thin the endometrial lining.

During the Procedure. Endometrial ablation is an outpatient procedure. The doctor usually applies a local anesthetic around the cervix. (The patient also receives medication for pain and to help her relax.) The doctor will dilate the cervix before starting the procedure. Patients may feel some mild cramping or discomfort, but many of the newer types of endometrial procedures can be performed in under 10 minutes.

After the Procedure. Patients may experience menstrual-like cramping for several days and frequent urination during the first 24 hours. The main side effect is watery or bloody discharge that can last for several weeks. This discharge is especially heavy in the first few days following ablation. (Patients need to wear pads, not tampons during this time, and to wait to have sex until the discharge has stopped.) Patients are generally able to return to work or normal activities within a few days after the procedure.