Women who continually suffer from heavy menstrual bleeding often seek relief from their OB/GYN to improve their quality of life. There are many different gynecological conditions that can cause heavy bleeding, including endometriosis, adenomyosis, uterine fibroids, polyps, etc.
Too often, endometrial ablation is recommended as a treatment option to stop heavy bleeding, but it is not the best choice. It is important to have a clear understanding of this procedure and understand what it is, the conditions it can treat, and side effects such as post-ablation syndrome, there is also a possibility of uterine ablation side effects that can occur years later.
An Overview Of Uterine Ablation
Endometrial ablation is a procedure that destroys the lining of the uterus to help reduce heavy menstrual bleeding. It is not a procedure for anyone who desires future fertility.
The procedure is done through the vagina and cervix, so no incisions are needed, and the tools used to complete the procedure will vary depending on the technique chosen. Ablations to destroy and remove the uterine lining can be done using heated fluid, extreme cold, radiofrequency energy, microwaves, etc.
In some cases, the procedure is done right in the doctor’s office, or it may need to be performed in a hospital or surgical center. The technique used and procedure location depend on the expertise and specific familiarity of a particular device or devices that are used in performing the procedure by the gynecologist.
What To Expect After An Ablation Of The Uterus
After the procedure, you will probably experience some cramping along with vaginal bleeding or spotting for a few days. It is also very common to have a watery discharge, which can last for one to two weeks. Since everyone recovers at their own rate, recovery times vary from person to person, but most people are back to most of their normal activities within two weeks.
It is important to always use birth control after ablation because it is still possible to conceive, but a viable pregnancy is very unlikely due to the damage to the uterine lining and could be dangerous for both mother and baby.
Endometrial Ablation Long-Term Complications
This procedure can be a good solution for extrauterine (outside of the uterus) causes of heavy uterine bleeding (e.g., medication-related, ovulatory disorder, thyroid disorder, bleeding disorder), but unfortunately, many times ablation is used in women with fibroids. This often results in suboptimal or poor results as the lining is not the problem for these women, but rather it’s the fibroids. That’s why ablation works best for extrauterine causes of the heavy bleeding as the heavy bleeding from these women is due to the lining itself.
As with any procedure, it is important to understand the potential long-term uterine ablation side effects and complications that may arise after the procedure.
Hematometra And Hematosalpinx
A 2007 study conducted on endometrial ablation and long-term complications found that some women developed chronic pain due to blood that became trapped behind scar tissue. This can happen because, after the ablation, the ovaries continue sending hormonal signals that tell the uterus to build and shed its lining each month, but since the uterine lining has been destroyed, the blood has nowhere to go and gets trapped. When this blood collects inside the uterus, it is called hematometra, and if it backs up into the fallopian tubes, it is known as hematosalpinx. Both of these conditions can cause pelvic pain and discomfort that can continue for years.
This complication commonly occurs in women with adenomyosis and often goes unreported. Many of these patients are not even aware they have adenomyosis as these women are often misdiagnosed with fibroids. It is one more reason why ablation should not be performed for women with a uterine structural cause for their bleeding (e.g., fibroids, adenomyosis, polyps, cancer).
Late-Onset Endometrial Ablation Failure (LOEAF)
LOEAF is another potential endometrial ablation long-term complication that can occur due to the formation of post-procedure scar tissue. This is a condition that involves bleeding and pelvic pain that returns months or even years after an endometrial ablation. This can happen because scar tissue forms and blocks the uterus, or because some of the uterine lining grows back even though the ablation was meant to permanently remove it. When this occurs, blood can get trapped and cause chronic pelvic pain and can also make it harder for doctors to accurately assess the condition of the uterus during future exams.
PATSS (Post-Ablation Tubal Sterilization Syndrome)
PATSS is a condition that happens when blood gets trapped in the fallopian tubes after an endometrial ablation and tubal sterilization. Since the uterus can no longer shed its lining as designed, some blood may build up and cause the fallopian tubes to stretch, which can cause pelvic pain that comes and goes with each menstrual cycle.
Intrauterine Adhesions (Asherman’s Syndrome)
This condition occurs when scar tissue forms inside the uterus and partially or completely blocks the uterine cavity. It is similar to LOEAF and can be triggered by different procedures, including ablation, and can cause lighter periods, missed periods, infertility, and complications with pregnancy. Asherman’s syndrome does not always cause pain, but if blood becomes trapped inside the blocked uterus (hematometra), it can create chronic pelvic pain.
Complicates Diagnosis of Other Uterine Conditions
Intrauterine scarring that occurs due to endometrial ablation can hinder the detection of conditions like endometrial cancer and potentially delay the diagnosis and treatment.
Other Long-Term Endometrial Ablation Side Effects
Urinary Incontinence
Some women may experience issues with a weak bladder after endometrial ablation. The procedure is meant to target only the uterine lining to reduce or eliminate heavy bleeding, but it can sometimes affect nearby structures, including the bladder and pelvic floor muscles.
Hair Loss
Some women report hair loss after endometrial ablation, but it is not a common side effect of the procedure itself. Hair thinning or shedding is usually linked to hormonal changes, stress, or underlying health conditions that can be triggered or made worse by the ablation.
How Often Does Endometrial Ablation Fail?
Studies have shown that about 25% of women who undergo the endometrial ablation procedure will eventually require a hysterectomy within five years, and there are many others who have less than satisfactory results and do not receive the relief they desire.
Some signs of endometrial ablation failure and that the procedure did not work include:
- Your menstrual bleeding continues or returns to being heavy.
- You continue or begin to experience ongoing pelvic pain or cramping.
- You begin to experience new symptoms like changes in your menstrual cycle or unusual discomfort.
Is Endometrial Ablation Worth It?
Deciding whether endometrial ablation is worth it for you would depend upon underlying conditions that are triggering heavy bleeding and your individual circumstances. Some things to consider before deciding to undergo an ablation procedure include:
How Effective It Will Be
It is important to understand what conditions are best treated with ablation and what conditions will not respond to this form of treatment. For instance, heavy bleeding that is caused by uterine fibroids will not be effectively treated with ablation, and a better choice would be through uterine fibroid embolization (UFE). This requires a second opinion from an Interventional Radiologist who is experienced in performing the UFE procedure.
Consider The Risks
Potential risks can include loss of fertility, infection, bleeding, injury to surrounding organs, and long-term complications like those mentioned previously.
What Other Alternatives Are Available
You may wish to consider other less invasive treatments such as medication (e.g., ibuprofen, tranexamic acid) or a uterine fibroid embolization (UFE) procedure.
It is very important to talk with your doctor to ensure you have all the information you need to make an informed decision before choosing any type of irreversible procedure like an endometrial ablation.
Ablation Alternative For Uterine Fibroids And Adenomyosis
Heavy menstrual bleeding is often caused by uterine fibroids or adenomyosis, but ablation is not a good treatment option for either of these conditions. In fact, in most cases of ablation performed in adenomyosis patients, their bleeding gets worse! This is not hard to understand once you know how the procedure works and what adenomyosis is. The uterine lining is thin, and there is a thick muscle layer beneath it. The ablation device is designed for a very thin burn corresponding to the thin thickness of the lining (i.e., so as not to burn the underlying muscle). In adenomyosis, the lining cells infiltrate (sometimes deeply) into the muscle layer, and performing a thin burn will be analogous to peeling off a scab to expose a raw bleeding surface beneath it.
For uterine fibroids, the bleeding can improve, but it is often not adequate as the ablation does not attack the culprit, i.e., the fibroid(s), but rather tries to address one symptom. Fibroid patients often have bulk-related symptoms (e.g., pelvic pain, increased urinary frequency/nocturia) that are not addressed at all by the ablation.
Uterine Fibroid Embolization (UFE) Is Better Than Ablation
One of the most effective non-surgical treatments to eliminate heavy bleeding due to fibroids or adenomyosis is Uterine Fibroid Embolization (UFE). This minimally invasive procedure blocks the blood supply that the fibroids or adenomyosis need to thrive and causes them to shrink and die.
During the UFE procedure, tiny particles are injected into the blood vessels supplying these areas to block the flow of blood to them. The normal uterus continues to receive a normal blood flow. Therefore, the uterus is alive, but the fibroids begin to die off. As this occurs, they soften and shrink, and this leads to a resolution of their symptoms. Most women recover in less than a week and return home the same day with just a small bandage. Unlike an ablation procedure, a hysterectomy, or a myomectomy, UFE does not remove or damage your uterus or eliminate your ability to become pregnant in the future. In fact, most pregnancies that occur after a UFE procedure will be full-term and vaginal, whereas that will not occur following myomectomy (c-section), hysterectomy (no birth), or ablation (no birth).
Why Many Women Are Not Told About UFE
UFE is performed by an interventional radiologist, not an OB/GYN, which is why many women are not informed about this option. Instead, they are often only offered surgical procedures like hysterectomy, myomectomy, or endometrial ablation.
How To Avoid The Negative Side Effects Of Ablation
If you are experiencing heavy bleeding due to fibroids or adenomyosis, Dr. John Lipman and his team at The Atlanta Fibroid Center are ready to help. They specialize in the UFE procedure and are dedicated to helping women like you to find the best treatment to eliminate fibroid-induced heavy bleeding.
Schedule a consultation today to learn how UFE can help you live a better quality of life tomorrow and for the years to come.
