What is Endometrial Ablation?- How to Prepare, Risks, Cost & Alternative Treatment

Endometrial ablation is a process that removes the linings or ablates of your uterus. The main goal of this process is to decrease the menstrual flow. No incisions are required for endometrial ablation. Your healthcare expert will insert a thin tool through a passage created between the uterus and vagina. 

If you are interested to know more about it, keep reading!

Endometrial ablation is a surgical procedure that destroys the uterus lining (which is known as the endometrium). It is a proven procedure for heavy periods that are usually performed by a gynaecologist.

Endometrial ablation is done to treat excessive loss of blood during menstruation. A doctor recommends endometrial ablation if you experience the following conditions:

• Unusually excessive bleeding during menstruation. This may be defined as soaking a tampon or pad every two hours or less than that.
• Causing anaemia due to excessive loss of blood
• Bleeding that continues for more than 8 days

Doctors usually begin by prescribing medicines or an intrauterine device to decrease menstrual bleeding. Endometrial ablation may be an option if these treatments fail to provide results or if you cannot have other therapies. 

Doctors do not recommend endometrial ablation if you have: 

• Cervical or vaginal infection
• Uterine cancer
• Pelvic inflammatory disease
• A weakened uterine muscle wall
• Previously undergone uterine surgery due to fibroids
• Recent pregnancy
• Vertical C-section incision
• Intrauterine device (IUD)
• Abnormal shape or structure of the uterus

If you are going for endometrial ablation to treat excessive menstrual bleeding, then a few weeks before, you may need to tell essential details to the doctor or go through some tests. All such details are mentioned below:

• Your doctor may explain the entire process to you. During such an explanation, ask your doctor any questions about this process. 
• You may need to sign a consent form to permit your doctor to carry out this process. Read the form thoroughly and ask questions if something is unclear to you.
• Your doctor may ask you to stop drinking and eating for 8 hours before performing the test. You need to do this fasting usually during midnight.
• The doctor may conduct a pregnancy test. Besides, communicate about any issues related to allergies to latex, anaesthetic drugs, medicines, or tape. 
• You need to tell your doctor about the medicines you are consuming. Such medicines include over-the-counter medicines, prescriptions, and herbal supplements. 
• Tell your doctor if you are suffering from any bleeding disorder. 
• If you have any blood-thinning medicine or other medicines that impact that blood clotting, then tell your doctor. Your doctor may ask you to stop taking these medicines before endometrial ablation. 
• Your doctor may prescribe some medicines to take for a few weeks to make endometrial tissues thin before the procedure. 
• The doctor may also provide some medicines that will make you sleepy. Therefore, someone should accompany you after taking this medicine to drive you home.

• If you have a health insurance with critical illness cover, inform your insurance company priorly and save all the bills for reimbursement of the treatment. 

Here are some of the risks that may arise from endometrial ablation:

• Bleeding
• Tearing of the bowel or uterine wall
• Infection
• Excessive fluid into your bloodstream

Communicate with your healthcare expert if you are going through the following condition:

• Allergic to latex, medicines, or iodine
• You are pregnant, or you are expecting to be pregnant. This is extremely important to tell your healthcare expert or doctor because undergoing endometrial ablation during pregnancy may cause miscarriage.

You may suffer from other risks depending on your condition. Therefore, make sure you communicate with your doctor properly about any concerns before opting for endometrial ablation.

If you are undergoing an Endometrial Ablation, you can expect a few things such as getting an explanation of the procedure etc. However, these things usually depend on the health care facility and medical professionals. Regardless of that, a few things that you can expect might include the following:

• You might have to sign a consent form to perform the procedure.
• Medical professionals can also advise you to fast for 8 hours before the test. 
• You must provide your doctor details about your pregnancy, allergy, bleeding disorder or any health complications. 
• Depending on your condition, you might also need to stop taking a few medications.

Before performing endometrial ablation, the doctor performs anaesthesia. The type of anaesthesia depends on the process that your doctor will perform. 

Alternatively, he or she can do anaesthesia while you are awake under epidural or spinal anaesthesia. During this process, the anesthesiologist will check your blood pressure, heart rate, oxygen in your blood, and breathing condition. 

You can expect the following process during the endometrial ablation:

In Ablations Using a Hysteroscope

• First, you need to wear a gown provided to you at the hospital.
• Your doctor may start an intravenous line in your hand or arm.
• You need to lie down on an operating table for a pelvic checkup.
• The doctor may place a catheter inside your bladder to drain urine.
• After this, your doctor will insert a speculum into your vagina to widen and check the cervix. He or she will clean it with an antiseptic solution. 
• Your doctor may use forceps to hold the cervix to begin the procedure.
• The doctor will open the cervix by inserting thin rods. This process will help to open the cervix wider to insert the hysteroscope.
• After opening the cervix, he or she will put a hysteroscope into the uterus.
• Your doctor may use gaseous or liquid carbon dioxide to fill the uterus for a better view of the uterus.
• The doctor will place an ablation tool through the hysteroscope. Now, he or she will move a wire loop or roller ball with the help of electric power across the uterus to remove its lining.
• After completing the process, your doctor will remove excess fluid from your uterus and take out the instrument.

In Other Types of Endometrial Ablation

In the case of the other types of ablation, you need to go through the following process:

• You need to remove your clothes and be asked to wear a gown provided to you by the hospital.
• A healthcare provider will start an intravenous line in your hand or arm.
• After lying down on a procedure table, your doctor will place a tool called a speculum into your vagina to widen it and see the cervix. 
• Your doctor will clean the cervix and will numb the part.
• He or she will put a thin rod-like tool through the cervix. This step examines the length of your uterus and cervical canal. You may experience a cramp once the doctor inserts this tool. After the examination, the doctor will remove it. 
• After this procedure, the doctor begins with endometrial ablation. Usually, other than hysteroscope, there are different types of endometrial ablation, and they are as follows:
  • Balloon Ablation – In this treatment, your doctor will insert a small balloon device, through the cervix,  inside your uterus. He or she will use the hot liquid in the balloon to remove the uterus lining. A computer is used to regulate the temperature, pressure, and time taken to complete the process. In this process, you may experience mild to strong cramping. 
  • Cryoablation – For this treatment, the doctor will insert a distinct probe, through the cervix, inside your uterus. After this, he or she will put an ultrasound transducer over your abdomen. This tool will assist the cryoablation probe in determining the correct areas in your uterus for freezing. You may feel mild to strong cramps in this process. 
  • Radiofrequency - Your doctor will put a particular mesh through the cervix and enlarge it to fill your uterus. Your doctor will pass a radio wave energy into the mesh to remove the lining of your uterus. Suction eliminates steam, liquid, and other gases produced during ablation. This may give moderate to strong cramping.
  • Microwave – In this treatment, your doctor inserts a wand through your cervix. This wand releases a microwave and heats the endometrial tissues. This treatment is completed within 3 to 5 minutes
  • Free-flowing Hot Fluid - The doctor circulates a heated saline liquid within the uterus for 10 minutes. This treatment is extremely beneficial for women with irregular-shaped uterus caused due to abnormal growth of tissues such as uterine fibroids and intracavitary lesions that disfigure a uterus.
• Whichever process your doctor employs in removing the uterus lining, he or she will remove the tools after completing the process.

The recovery process after endometrial ablation may vary based on the type of anaesthesia and ablation you had. If you have epidural, spinal or general anaesthesia, healthcare providers will take you to the recovery room. 

Once they check your blood pressure, breathing and pulse are stable and you are awake, they will either send you home or take you to your hospital. If you had endometrial ablation as an outpatient, someone should be available to drive you home after this process. 

If you have not received any anaesthesia, doctors prescribe taking rest for around 2 hours before sending you home. 

After this procedure, you may experience vaginal bleeding for some days. Apart from this, you may also have watery-bloody discharge for a few weeks. 

Other after-effects of this procedure include nausea, cramping, vomiting or an urge to urinate frequently for the first few days post this process. However, note cramping may last for a longer duration than other effects. 

• You may take medicines as prescribed by your doctor to relieve cramping. Note, take only those medicines as recommended by doctors and do not consume aspirin or related medicines as they may further increase the possibility of bleeding.
• Besides, here are a few tips that you should consider following after undergoing endometrial ablation:
• Avoid showers for baths, sexual intimacy or tampons for at least 2 to 3 days after this process. 
• Do not do any heavy lifting or other strenuous activity 
• You may follow a regular diet unless your doctor recommends you otherwise. 
• Consult with your doctor about the type of birth control suitable for you before taking the same

Consult your doctor immediately if you experience the following:

• Poor-smelling drainage from your vagina
• Chronic abdominal pain
• Chills or fever
• Difficulty in urinating
• Excessive bleeding, or heavy bleeding that lasts for 2 days after this procedure

You might need to call your doctor for endometrial ablation if you are experiencing long or heavy periods. Additionally, you can also choose these surgical procedures if you are experiencing bleeding between periods, hampering your quotidian activities and causing anaemia.

Take a look at the alternative treatment options other than endometrial ablation to cure excessive bleeding:

1. Hysterectomy

This is the most invasive treatment to cure excessive bleeding during menstruation. This surgical process involves risks that are present in major surgeries. However, it is beneficial in ceasing bleeding completely because a surgeon eliminates the uterus in this surgery. 

It is performed in a hospital under general anaesthesia. Remember that the recovery in this process takes longer than endometrial ablation. Besides, you cannot be pregnant after undergoing this process as it removes the uterus.

2. Hormonal and Non-hormonal Drug Therapies

You can avail of hormonal treatment in the form of patches, oral contraceptive pills or injections. Doctors often prescribe this alternative before recommending an invasive treatment like endometrial ablation. 

Your doctor may also prescribe intrauterine hormonal devices. The doctor inserts these devices or systems inside your uterus to control bleeding and contraception. 

Your doctor may prescribe non-hormonal medications without or with hormonal therapy. Certain types of medications include non-steroidal anti-inflammatories and tranexamic acid, which are used to decrease excessive menstrual bleeding. 

Note that these therapies need repeated use to get the results. Each treatment has its own risks and benefits. Therefore, you should discuss the same with your doctor. Moreover, these therapies do not leave any permanent impact on fertility. This means that you will still have the option of getting pregnant in the future.

To conclude, it is essential to know all the details of endometrial ablation before going through the process. However, this treatment is not recommended for every woman suffering from excessive bleeding. Moreover, consult your doctor immediately if you notice the continuation of excessive menstrual bleeding or long periods even after this process.

In India, the cost of Endometrial Ablation is around ₹ 4,27,000. But, it typically ranges between ₹50,000 to ₹5,00,000 depending on the cause of the problem, the hospital you choose, the city of treatment and the doctor’s fees. It is better to check and compare prices in advance before undergoing treatment.

However, you can also get covered for endometrial ablation if you have a health insurance policy. Confused? In simple words, if you have health insurance, you can get coverage for the expenses incurred in endometrial ablation treatment only if it is included in the policy. 

So it’s better to compare different health insurance policies and buy the best one as per your requirement.