DEAR MAYO CLINIC: I'm 37 years old. Over the past 18 months, my periods have become extremely heavy. I've gone through an evaluation, and my doctor recommends an endometrial ablation. What does this procedure involve? Will I still have a period every month afterward? What are the risks of endometrial ablation?
NSWER: Endometrial ablation destroys the lining of your uterus. The procedure often can be a useful treatment for women who have very heavy menstrual flow. After endometrial ablation, many women still do have periods, but they're much lighter. The procedure is generally safe, and the risks associated with it are low. But you need to be finished having children to consider this option.
During your period, your body sheds the lining of your uterus. That lining is called the endometrium. When periods become unusually heavy on a regular basis, you need to have the condition evaluated. For example, if you produce enough blood to soak through a pad or tampon in one hour on your heaviest days, that's generally considered very heavy flow. Treatment often is available that can help.
In some cases, hormonal medications, birth control pills, or an intrauterine device may be treatment options for reducing menstrual bleeding. Endometrial ablation may be recommended if those choices are not enough, or if a woman prefers not to use them.
Your doctor can perform an endometrial ablation in several ways. Although the specific techniques vary, the endometrium typically is destroyed through the use of instruments that deliver heat or extreme cold to the uterine lining. Ask your doctor to describe the method to be used in your situation.
In many cases, the procedure can be done on an outpatient basis, so you don't need to stay overnight in the hospital. No incision is needed, as the instruments used during the procedure pass through the opening of the cervix.
For a few days after endometrial ablation, you may have some cramping. Over-the-counter pain medications typically are enough to control the discomfort. Watery vaginal discharge mixed with some blood also is common after the procedure. This may last for a few weeks.
As with all surgical procedures, endometrial ablation does have some risks. They include the possibility of injury to the uterine wall from the surgical instruments, as well as cold or heat damage to organs near your uterus. Bleeding and infection can happen due to endometrial ablation, as well. All of these complications are uncommon.
One long-term drawback to endometrial ablation is that it makes evaluation of any future abnormal uterine bleeding challenging because of scarring in the uterine lining. Getting an adequate tissue sample of the uterine lining for a biopsy can be difficult, if not impossible. In some cases, that may lead to the need for a hysterectomy.
Before you have endometrial ablation, it's very important that you carefully consider whether you may wish to become pregnant in the future. Endometrial ablation is only recommended for women who've completed child bearing. However, it is not a form of birth control, and you still need reliable contraception. Pregnancies that occur after endometrial ablation often end in miscarriage because the remaining uterine lining cannot sustain a pregnancy.
Endometrial ablation typically is successful in significantly reducing menstrual flow. It may take a few months to see the full effect. But after that, most women have lighter, more manageable periods. In some women who undergo endometrial ablation, periods may stop completely. -- Stephanie Faubion, M.D., Women's Health Clinic, Mayo Clinic, Rochester, Minn.
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