Endometrial ablation is a minimally invasive procedure done to treat heavy menstrual bleeding (also known as abnormal uterine bleeding). There are several reasons why a woman has increased menstrual flow. These include benign uterine growths such as fibroids or endometrial polyps, cancer of the uterus and hormonal problems.
The procedure works by removing the lining of the uterus (the endometrium), which is the tissue that builds up each month and sheds during a menstrual period.
The endometrium is the layer of tissue inside the uterus. The endometrial cells have a monthly cycle of growth and collapse which is stimulated by the ovarian hormones. The number of cells and blood vessels increase over the cycle, in preparation for the implantation of the fertilised embryo. When there is no pregnancy, the endometrial cells die and shed, exposing the uterine vessels and starting the menstrual flow.
By reducing or eliminating this lining, endometrial ablation can significantly reduce menstrual bleeding, and in some women, periods may stop altogether.
The procedure is typically performed as a day procedure, often using hysteroscopy or specialised ablation devices.
There are four main groups of treatment for abnormal uterine bleeding depending on the cause:
- Hormonal medication: these contain either oestrogen or progesterone or a combination of both and can be taken as tablets or injections.
- Levonorgestrel IUD: Mirena is the brand name of an intrauterine device that contains a progesterone like hormone. Once inserted inside the uterus, it releases small amounts of hormones which eventually thin the endometrium and reduce the menstrual flow.
- Endometrial Ablation: surgical procedure to destroy the endometrium preventing its monthly growth and shedding thus reducing the menstrual flow.
- Hysterectomy: When the other measures fail, removing the uterus may be the only way to completely stop menstrual bleeding.
Medical treatment and the Levonorgestrel IUD are fully reversible and can be used by women who still want to preserve fertility. Endometrial ablation cannot be performed on women who want to preserve their ability to fall pregnant.
