Who needs hysteroscopic endometrial ablation?

Excessive menstrual blood loss can be treated with endometrial ablation. If the patient experiences any of the following symptoms, the doctor may recommend an endometrial ablation:

• Unusually heavy periods
• Frequently changing a pad or tampon every two hours or less
• Bleeding that lasts for more than eight days
• Anemia due to excessive blood loss

Doctors usually start by giving drugs or an intrauterine device to control menstrual bleeding (IUD). If these treatments don't work or the patient cannot have other therapy, endometrial ablation may be suggested as an alternative.

What are the different types of endometrial ablation?

Endometrial ablation is non-invasive (no incision is required); thus, the doctor makes no surgical cuts. Instead, the doctor will use very thin equipment to reach the uterus through the vaginal canal. The procedures will vary depending on the sort of ablation performed.

Here’s a list of procedures that are commonly used:

1. Hydrothermal- The doctor will gently pump fluid into the uterus before heating it. The uterine lining is destroyed within 10 minutes.
2. Balloon therapy- It involves the doctor inserting a thin tube into the uterus with a particular balloon on end. The balloon is filled with heated fluid, which expands and destroys the lining.
3. High-energy radio waves- The doctor stretches the uterus by inserting electrical mesh. The lining is then damaged by energy and heat sent by intense radio waves, which is then suctioned out.
4. Freezing- The uterus lining is frozen using a thin probe with an extremely cold tip. This procedure is known as "cryoablation".
5. Microwave- Microwave energy is applied to the uterine lining through a special wand, which destroys the lining.
6. Electrical- The doctor can use an electric current to destroy the uterus lining, but this approach is less commonly used.

How is endometrial ablation performed?

The procedure is as follows:

• In the arm or hand, an intravenous (IV) line may be started.
• As with a pelvic exam, the patient will lie on an operating table with the feet and legs supported.
• To drain urine, the healthcare practitioner may insert a catheter into the bladder.
• An instrument (speculum) will be inserted into the vagina by the healthcare provider. The patient will use it to enlarge the vaginal opening so that the cervix may be seen.
• The cervix will be cleaned with an antiseptic solution by the healthcare provider.
• A sort of forceps may be used to hold the cervix steady during the process.
• Thin rods will be inserted into the cervix to open it up. Each rod will be larger in diameter than the one before it. The cervix opening will progressively widen, allowing the provider to insert the hysteroscope.
• The hysteroscope will be inserted through the cervical opening and into the uterus by the healthcare professional.
• To fill the uterus, the surgeon may use a liquid or carbon dioxide gas. This will enable them to see the affected area more clearly.

What are the possible risk factors for the patients?

The risks of having endometrial ablation are rare, and they are:

• Pain
• Bleeding
• Infection
• Damage to nearby organs
• Injury on uterus wall caused by other tools

What can you expect during post-surgical care for hysteroscopic endometrial ablation?

After ablation, the patient generally recovers quickly. Most patients are back to their normal routine within a few days.

For the first 24 hours, the patient will feel nauseous and have a strong desire to pass urine.

The doctor will advise not to have intercourse, use tampons, or a douche for a few days. They may also impose restrictions on other activities. If the patient requires pain medication, the doctor will determine whether over-the-counter medicines are safe to use.

Aspirin must be taken only if necessary, and it may cause the patient to bleed much more.

If any of the following symptoms are experienced, contact the doctor right away:

• Vaginal discharge with a strong odor. For a few weeks, the patient may have a watery discharge mixed with blood. For the first several days after the surgery, the discharge is usually more intense.
• Cramps or stomach ache that lasts a long time. For a few days, the patient may have menstrual-like cramping. Ibuprofen or acetaminophen are two over-the-counter drugs that can aid with cramps.
• Heavy bleeding or bleeding that persists for more than two days after the ablation (though spotting is normal)
• Peeing problems will occur. During the first 24 hours following endometrial ablation, the patient may need to pass urine more frequently.
• Fever
• Chills

Endometrial ablation does not usually produce long-term results, and the periods may become heavier and longer again after a few years. If this is the case, inform the doctor as the patient may require a different treatment.