Why it's done
Endometrial ablation treats excessive menstrual blood loss by causing your endometrium (lining of your uterus) to scar by heating it, which may be indicated by:
Unusually heavy periods
Enough blood loss to soak through a pad or tampon every hour on the heaviest days
Anemia from excessive blood loss
Several options exist to help reduce menstrual bleeding. Doctors may prescribe medications as the first line of treatment for heavy menstrual bleeding, but endometrial ablation may be an option if medical options do not help.
Endometrial ablation is not recommended for women who:
Wish to become pregnant in the future
Have cancer of the uterus
Are past menopause
Risks of Ablation
A puncture injury (perforation) of the uterine wall from surgical instruments
Heat damage to nearby organs
Pain, bleeding or infection
It is recommended to employ some form of birth control (preferably permanent) after endometrial ablation, since pregnancy is still possible in some women, and these pregnancies are higher risk to both mother and baby. The pregnancy may end in miscarriage because the lining of the uterus has been damaged. Other risks of pregnancy include fetal growth concerns. Women who want to become pregnant in the future should not have endometrial ablation. You should decide on a birth control option prior to having an ablation.
Prior to your procedure
You may have an ultrasound with or without saline to evaluate your endometrial lining for concerns of thickening and polyps, and to evaluate the shape of your uterus in order to provide you with the optimal form of ablation.
Your doctor may take a small sample of your endometrium using a small instrument inserted through the opening of your cervix, so it can be tested for cancer. If you have endometrial hyperplasia or cancer, you'll probably need to have a hysterectomy instead of endometrial ablation.
During the procedure
You may have your ablation done in your doctor’s office or the hospital/surgery center, depending on the type of anesthesia you prefer.
Initially the opening of your cervix will need to be dilated to allow for the passage of the instruments used in endometrial ablation.
Initially a small camera (hysteroscope) will be placed through your cervix, into your endometrial cavity. At that point your doctor will evaluate your uterine lining and make sure it is safe to proceed with your ablation. After the doctor ensures everything is safe, the equipment double checks for no leaking of fluid inside and outside of your uterus by measuring closely the volume and pressure. Once your doctor and the equipment have ensured that everything is safe the procedure is started. Once the ablation starts, free-flowing hot fluid. (Hydrothermal Ablation) is heated to 176 to 194 F (80 to 90 C) while it is circulated within the uterus for about 10 minutes. After the procedure the fluid is cooled and then the instruments are removed. This method is one of the more effective methods, since it is most likely to get complete coverage of your endometrial (uterine) lining.
After your endometrial ablation, you may experience: Cramps. You may have menstrual-like cramps for a few days. It is very important to take the pain medication as prescribed for the next couple of days; otherwise, you may develop severe cramp-like pain following the procedure.
Vaginal discharge. A watery discharge, mixed with blood, may occur from a few weeks to a few months. The discharge is typically heaviest for the first few days after the procedure.
Frequent urination. You may need to pass urine more often during the first 24 hours after endometrial ablation, due to irritation of your bladder.
You should avoid intercourse or anything vaginally until the bleeding and discharge stops. Usually for about 4 weeks.
It may take a few months to see the final results, but endometrial ablation usually succeeds (about 85% of the time) in reducing the amount of blood lost during menstruation. Most women will have lighter periods, and some will stop having periods entirely.
Continue to use contraception, though, because endometrial ablation isn't a sterilization procedure. Pregnancy may still be possible, but it will likely be hazardous and/or end in miscarriage.
Hydrothermal Ablation Pre and Post Operative Instructions
In hospital or surgery center: Do not eat or drink for 8 hours before your surgery time.
In Office: You may eat lightly prior to your procedure. Please do not eat a large meal just prior to the procedure. You should have something light in your stomach when you take the medications.
Medications: The evening before your surgery: VERY IMPORTANT! Both in the hospital/surgery center and in office: Take Ibuprofen 800mg the night before, unless you are allergic to or cannot take. If so please contact us at (509) 628-8866 and speak to the nurse or doctor about this.
The morning of surgery In hospital or surgery center: Follow your preoperative instructions given to you at your preoperative meeting. In office: Bring all of your medications that you were prescribed with you to your appointment, these should include:
- Ibuprofen 800mg (treats pain and cramping)
- Oxycodone or Hydrocodone with acetaminophen (Percocet or Lortab) (pain medication)
- Hydroxazine 50mg (helps prevent nausea)
- Xanax 0.25mg (helps relaxes and prevents anxiety)
- Torodol 30mg (pain medication and relaxes the uterus)
Arrive at the time of your appointment, which is approximately one hour before your procedure.
In hospital or surgery center: You will be checked in and brought to the preoperative area. Here the preoperative nurse will greet you, start your IV, and anesthesia will meet with you. Your physician will meet you prior to going back to the operative room.
In office: Once you are checked in you will be asked to provide a urine specimen for a pregnancy test and asked to sign a consent. After which time you will be given an injection of Toradol Analgesic, which needs to be in your system for at least 45 minutes before your surgery. You will then be taken back to the procedure room and given a local anesthetic into your cervix, which will provide most if not all of the pain relief during your procedure.
Procedure: Please see YouTube video. Genesys HTA Procedure Animation
Post-operative instructions (After hospital, surgery center and office procedures)
Going home you will need someone to drive you home after your procedure.
Discomfort is usually the most significant 2-6 hours after Hydro Thermal Ablation. Please take your pain medication on a regular basis the day of your procedure and the following day on a regular basis.
Ibuprofen 800mg Take every 8 hours following the procedure.
Percocet or Lortab Take every 4 hours following the procedure.
Hydroxazine. Take every 6 hours following the procedure as needed for nausea.
Additionally a heating pad to your abdomen or a warm bath can provide additional relief. Please notify us for severe pain that is not well controlled by your pain medication. (509) 628-8866.
Fever may be a sign of infection. If you experience chills take your temperature immediately. Please call us if it is 100.6 Fahrenheit or more during the first 3 days after your procedure.
Nausea may occur for the first 4-6 hours following the procedure. You may take your Hydroxazine if you need to. The nausea usually can be controlled with clear fluids, ginger ale, or other carbonated fluids. If it is severe and unrelieved, call us. (509)628-8866
Diet should be whatever you feel like eating after the procedure.
Discharge following this procedure can be variable. Anything from a watery discharge with occasional blood-staining, passage of clumps of gray tissue, to menstrual-like bleeding for up to 4-6 weeks is normal. You may also have a minimal discharge. Please do not use tampons or have intercourse for the first four weeks following Hydrothermal ablation.
Work may be resumed 1-2 days after this procedure. Any further questions please call (509) 628-8866
You will be scheduled for follow up prior to leaving after your procedure.