Endometrial ablation is the process of removal of the endometrial lining. This procedure is done by doctors and surgeons when women experience certain gynecological conditions. Women who undergo this procedure often wonder if pregnancy after endometrial ablation is possible.
The uterus or womb is a hollow pear-shaped female genital organ. The innermost lining of the uterus is the endometrium which is shed off every month during menstruation. In women, the cycle of building and shedding of the endometrial layer lasts for an average of 28 days. Some women complain of very heavy menstrual bleeding along with pain. This can hamper their day-to-day activities during periods. Endometrial ablation is a good alternative to help with heavy bleeding in such women.
In This Article
- What is Endometrial Ablation?
- Why is Endometrial Ablation Done?
- Is Pregnancy After Endometrial Ablation Possible?
- Are There Any Risks of Getting Pregnant After Endometrial Ablation?
- Process of Endometrial Ablation
- Are There Any Risks or Side Effects of Endometrial Ablation?
- Who should Not Opt For Endometrial Ablation?
- Precautions to Take After Endometrial Ablation
- FAQ’s
What is Endometrial Ablation?
Endometrial ablation is the procedure where a thin layer of the endometrial tissue is taken out (1). The ultimate goal of this procedure is to decrease the amount of heavy bleeding during periods. It’s a minimally invasive surgical procedure that doesn’t require any incision (1A).
Why Is Endometrial Ablation Done?
Endometrial ablation is helpful in women with heavy menstrual bleeding or menorrhagia (2). Periods are heavy if the bleeding lasts for more than 7 days and interferes with your daily normal activities. Changing tampons or pads every 1-2 hours can lead to anemia in women in the long run. Endometrial ablation helps treat this heavy bleeding and provides relief to women.
This treatment is an effective alternative option to hysterectomy for treating dysfunctional uterine bleeding (DUB) (3) when medical treatment is not giving good results.
Is Pregnancy After Endometrial Ablation Possible?
The chances of getting pregnant after ablation are quite low due to various complications. During ablation, disruption of the basal lining takes place, making implantation of an embryo quite difficult. According to studies, the pregnancy rate after ablation is around 0.24-5.2% (4). It can also cause grave maternal and neonatal morbidity. If pregnancy happens, then there is a great risk of early miscarriage (4B).
Are There Any Risks of Getting Pregnant After Endometrial Ablation?
Pregnancy occurring after endometrial ablation is seen to be associated with complications and risks.
Placenta accreta is a major complication of ablation (5).
Other risks include
Conception after ablation can be life-threatening too.
Couple counseling about the use of contraceptive methods after endometrial ablation is mandatory (4C).
[Read: What Are The Different Contraception Methods?]
Prcoess of Endometrial Ablation
There are many ways to perform endometrial ablation such as
1. Electrical Endometrial Ablation or Electrocautery
This process requires passing an electric current through a wire loop and a gentle application to the endometrial lining for tissue cauterization. This procedure requires general anesthesia.
2. Hydrothermal Ablation
In the hydrothermal ablation (6) process, the technician/doctor will inject heated saline liquid into the uterus. The liquid flows freely throughout the uterus for a few minutes and destroys the endometrial lining of the uterus owing to the high temperature.
3. Balloon Therapy
In this technique, a balloon catheter is introduced in the uterus. The catheter contains fluid that is heated to a certain point so that the endometrial tissues are easily eroded away (7).
4. Radiofrequency Ablation
In this type of ablation, the technician/ doctor will introduce a triangular mesh electrode in the uterine cavity that expands the cavity. The electric current from the electrode destroys the endometrial lining. This method is considered safe and effective (8)
5. Cryoablation (Freezing)
In this procedure, a very low temperature is used to destroy the endometrial lining. A probe is introduced in the uterine cavity that delivers freezing cold temperature to the uterine lining.
6. Microwave Ablation
In microwave ablation (9), the endometrial lining is destroyed by microwave energy by introducing a slender probe in the uterine cavity.
Are There Any Risks or Side Effects of Endometrial Ablation?
As with any other medical procedure, there are a few risks that can occur. The complications associated with endometrial ablation are
- Infection during the procedure
- Bleeding during or after the procedure
- Perforation of the uterus or bowel
- Overloading of fluid into the bloodstream
- Damage to surrounding structures due to the extreme heat and cold used during the process.
- Failure of endometrial ablation in rare cases, where the endometrial lining grows back abnormally following the procedure.
- Scarring and contractures in the uterus (10)
Women undergoing this procedure must start using any form of birth control because there is a high chance of miscarriage if pregnancy occurs. Many healthcare providers suggest sterilization after this procedure.
[Read : Birth Control Pills]
Who should Not Opt For Endometrial Ablation?
The endometrial ablation is contraindicated for females with the following conditions
1. Pelvic Inflammatory Disease
Women with active pelvic or urogenital infections must not go ahead with this procedure unless treated.
2. Desire For Pregnancy
Women who want to preserve their fertility should avoid going for ablation, as it minimizes the chances of pregnancy.
3. Suspected Malignant or Pre-malignant Conditions of The Uterus.
Ablation may interfere with the diagnosis of endometrial hyperplasia or endometrial carcinoma. Evaluation of these conditions may also be affected.
4. Intrauterine Device (IUD) Users
An IUD in the uterus is an absolute contraindication for ablation.
5. Uterine Anomalies
There are certain congenital anomalies of the uterus like septum and unicornuate uterus where endometrial ablation is better to avoid.
6. Vertical or Classical Cesarean Sections
There is a high risk of failure associated with previous C-section cases.
7. Myometrial Thinning Post-uterine Surgery
Women with a previous history of uterine surgery might have a very thin myometrium. This poses a risk to neighboring structures during the process of ablation.
[Read : Pelvic Inflammatory Disease (PID)]
Precautions to Take After Endometrial Ablation
Most women recover in 1-2 days post surgery. There are certain precautions which are necessary to take.
- Avoid douching or cleaning the vaginal area for nearly 2 weeks after ablation. There is a high risk of infections associated with douching.
- It’s better to avoid tampon use for the bleeding occurring a few days after the surgery. Instead, use a sanitary pad.
- Avoid sexual intercourse for at least a week after ablation. Advisable to wait till the discharge or bleeding stops.
- Refrain from lifting heavy weights or doing strenuous exercises.
- Avoid going for swims or soaking in hot water tubs for at least 3-4 weeks.
If you are struggling with heavy painful periods then, Endometrial Ablation can be a good option for you. It’s a minimally invasive surgery and has good results. Only if your family is complete, then you can consider this option, as pregnancy after Endometrial Ablation can be a bit tricky.
FAQ’s
1. Can I Get Pregnant After Endometrial Ablation?
The chances of getting pregnant after this procedure are quite low, but it can still happen. Although, there are many risks associated with pregnancy after this.
2. What Will Happen if I Get Pregnant After Endometrial Ablation?
Most of the pregnancies after endometrial ablation don’t end well. There is a great risk of early miscarriage. Later complications include preterm delivery, postpartum hemorrhage, and uterine rupture.
3. Does Endometrial Ablation Stop Your Period?
Most women experience regular light periods after the procedure. However, in some women, periods come to a stop.
4. Is Bleeding After Endometrial Ablation Normal?
Yes. Vaginal bleeding for a few days after this procedure is pretty normal and is a part of the recovery process. Must avoid the use of tampons for this bleeding.
References
- Endometrial Ablation – StatPearls – NCBI Bookshelf – [https://www.ncbi.nlm.nih.gov/books/NBK459245/]
- Confirming Menorrhagia Following Endometrial Ablation | AAFP – ]Confirming Menorrhagia Following Endometrial Ablation | AAFP]
- Dysfunctional uterine bleeding. – PMC – [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305317/?page=4]
- Pregnancy following ablation therapy: a literature review – ScienceDirect – [https://www.sciencedirect.com/science/article/pii/S2949838423000348]
- Abnormal Placentation with Placenta Accreta in a Post Ablation Pregnancy – [https://rdw.rowan.edu/cgi/viewcontent.cgi?article=1452&context=stratford_research_day]
- Hydrothermal Endometrial Ablation Can Reduce the Need for Hysterectomy and Transfusion – PMC – [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043566/]
- Modified Thermal Balloon Endometrial Ablation for Treatment of Heavy Menstrual Bleeding – PMC – [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9212179/]
- Radiofrequency endometrial ablation with a novel endometrial tip for the management of heavy menstrual bleeding and abnormal uterine bleeding: a prospective study – PubMed – [https://pubmed.ncbi.nlm.nih.gov/32619371/]
- Effectiveness of treating menorrhagia using microwave endometrial ablation at a frequency of 2.45 GHz – PMC- ]Effectiveness of treating menorrhagia using microwave endometrial ablation at a frequency of 2.45 GHz – PMC]
- Long-term complications of endometrial ablation: Cause, diagnosis, treatment, and prevention – ScienceDirect – [https://www.sciencedirect.com/science/article/abs/pii/S1553465007001562]
