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If Nothing Works to Treat Your Period, Endometrial Ablation Could Be an Option

For so many people who menstruate, getting their period is more than an inconvenience. It can be so heavy and painful that it becomes disruptive. While we’re nowhere close to where we need to be in terms of period pain management, there is an option to help make them lighter — a procedure called endometrial ablation.

The procedure — which takes around five minutes and is performed in a doctor’s office or surgery center — burns the lining of the uterus so there is less tissue that can bleed, explains Dr. Marc Winter, an OB-GYN at Saddleback Memorial Medical Center in Laguna Hills, California, who has lectured widely on endometrial ablation. The success rate is around 85 percent, he adds, and most patients are back to normal activity within one day.

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The procedure may be right for the patient who has heavy and/or painful periods — which may lead to anemia — provided their uterus is normal sized or only slightly enlarged with no evidence of endometrial cancer, according to Dr. Thomas Ruiz, an OB-GYN at Orange Coast Memorial Medical Center in Fountain Valley, California. It is often considered when neither hormones nor medications work.

Ruiz explains that the procedure is done by inserting the ablation instrument into the uterine cavity via the cervical canal — meaning there are no incisions. Depending on which system the provider is using — cold therapy, hot water or radio frequency energy — the procedure takes 10 to 20 minutes and can be done using a cervical block (local anesthesia), conscious sedation or general anesthesia, he adds.

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Typically, patients can return to work two to three days after the procedure, although the post-ablation discharge tends to last between two and four weeks, Ruiz says.

“This procedure is ideal for the working woman whose life is disrupted by her menstrual disorder and wants a procedure that causes minimal pain and a quick recovery,” Ruiz says.

But the procedure isn’t right for everyone. Winter warns, “it would be dangerous to get pregnant after this procedure, so you should be done having children prior to considering this.”

Ruiz agrees, saying that it is also not recommended for women who have had a pregnancy recently or those who are postmenopausal.

In order to determine whether you’re a good candidate, your gynecologist first performs a physical exam and obtains an ultrasound to check for conditions like large fibroids or adenomyosis (uterine lining in the muscle layer of the uterus), which will decrease the chances of success, Winter explains.

After the procedure, 50 to 70 percent of patients will stop having their periods altogether, and 15 to 35 percent of women will have lighter, less painful menstruation according to Ruiz.

Winter says the risks of the procedure are extremely small — 1 in 10,000 of injury to surrounding organs and that it’s a “great alternative” to hysterectomy for women who are not planning to get pregnant because it has a faster recovery time and fewer risks.

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When complications do occur, the most common is a minor, nonpermanent injury called uterine perforation — basically, putting a small hole in the uterus, Ruiz said. In even rarer cases, there could be infection or injury to the bowel or bladder.

If you think endometrial ablation could be right for you, bring it up at your next OB-GYN appointment to learn about this and other menstrual treatment options.

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