Endometrial Ablation

By Nancy Bowers

Procedure overview

What is an endometrial ablation?

Endometrial ablation is a procedure to permanently remove a thin tissue layer of the lining of the uterus to stop or reduce excessive or abnormal bleeding in women for whom childbearing is complete. The lining of the uterus is called the endometrium. In some cases, endometrial ablation may be an alternative to hysterectomy.

There are several techniques used to perform endometrial ablation including the following:

  • Electrical or electrocautery—electric current travels through a wire loop or rollerball that is applied to the endometrial lining to cauterize the tissue

  • Hydrothermal—heated fluid is pumped into the uterus and destroys the endometrial lining with high temperature

  • Balloon therapy—a balloon at the end of a catheter is inserted into the uterus and filled with fluid, which is then heated to the point that the endometrial tissues are eroded away

  • Radiofrequency ablation—a triangular mesh electrode is expanded to fill the uterine cavity. The electrode delivers electrical current and destroys the endometrial lining.

  • Cryoablation (freezing)-—a probe uses extremely low temperatures to freeze and destroy the endometrial tissues

  • Microwave ablation - microwave energy is delivered through a slender probe that has been inserted into the uterus and destroys the endometrial lining.

Some endometrial ablation procedures are performed using a hysteroscope, a lighted viewing device inserted through the vagina for a visual examination of the canal of the cervix and the interior of the uterus. Ablation instruments can be inserted through the opening and a camera or video camera can be used to record findings through the hysteroscope.

A resectoscope may be used instead of the hysteroscope. This device is similar to the hysteroscope but has a built-in wire that uses electrical current for resecting (removing) endometrial tissue.

Other ablation techniques use ultrasound to guide the instrument to the areas for treatment. Ultrasound is a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs.

Other related procedures used for treating the endometrium include dilation and curettage (D & C), hysteroscopy, endometrial biopsy, and hysterectomy. Please see these procedures for additional information.

What are female pelvic organs?

The organs and structures of the female pelvis are:

  • Endometrium—the lining of the uterus

  • Uterus—also called the womb, the uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.

  • Ovaries—two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored and where the female sex hormones estrogen and progesterone are produced

  • Cervix—the lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body

  • Vagina—the passageway through which fluid passes out of the body during menstrual periods. Also called the "birth canal," the vagina connects the cervix and the vulva (the external genitalia)

  • Vulva—the external portion of the female genital organs

The menstrual cycle

With each menstrual cycle, the endometrium prepares itself to nourish a fetus as increased levels of estrogen and progesterone help to thicken its walls. If fertilization does not occur, the endometrium, coupled with blood and mucus from the vagina and cervix (the lower, narrow part of the uterus located between the bladder and the rectum) make up the menstrual flow (also called menses) that leaves the body through the vagina. After menopause, menstruation stops and a woman should not have any bleeding.

Reasons for the procedure

Menorrhagia is a condition in which a woman has extremely heavy or prolonged menstrual periods. Bleeding between periods is called abnormal uterine bleeding. In some cases, bleeding may be so severe and relentless that daily activities become interrupted and anemia develops.