Is Uterine Ablation Right for Me?

Heavy bleeding is a bothersome problem for many people who menstruate. If initial treatment with hormone medications doesn't help, a procedure called uterine ablation may be an option. Here we’ll describe the procedure and its risks, as well as who may or may not be a good candidate for it.

What is uterine ablation?

It is a simple, one-time procedure that destroys, or ablates, the inner lining of your uterus. This inner lining is called the endometrium. (This is why the procedure is also called endometrial ablation.) Your menstrual period is essentially your endometrium shedding each month (give or take, depending on your cycle). Uterine ablation scars the endometrium, making your periods much lighter. For some, monthly periods may even stop completely. 

Who is a good candidate?

If you have heavy periods and no desire to get pregnant in the future, then you may be a candidate for uterine ablation. Your period is considered heavy if it lasts more than 7 days or if you have to change your pad or tampon every 1 to 2 hours. Passing large blood clots may also be a sign of heavier flow.  

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The goal of uterine ablation is to make your periods lighter. It could cause your periods to stop completely, but that doesn’t happen for everyone. If your goal is to stop your periods, you may need to consider other treatment options, like a hysterectomy, which involves removing the uterus. 

Are there any circumstances in which uterine ablation would not be recommended?

Uterine ablation is not right for everyone. It is not recommended if:

• You have cancer of the uterus. In that case, the cancer needs to be treated first.

• You have a condition called endometrial hyperplasia. This is an abnormal thickening of the inner lining of your uterus that can lead to cancer. (Your provider will check for this before performing a uterine ablation.)

• You were born with an abnormally shaped uterus. An example of this is a bicornuate uterus.

• You have a thinner-than-usual uterine wall. This could be due to previous uterine surgery, like a cesarean section or fibroid removal. With a thinned uterine wall, ablation can injure nearby organs like your bladder or bowel.

• You are past menopause. There is a higher likelihood that abnormal bleeding after menopause is due to cancer.

• You have an active pelvic infection. If the infection is not treated first, a procedure could make it worse.

• You plan to become pregnant in the future. Pregnancy after uterine ablation can be dangerous.

What to expect before and during the procedure

Before the procedure, you will need to have a few tests done, some with your provider’s help:

• A negative pregnancy test

• An ultrasound to check the size and shape of your uterus, and determine if there are any other abnormalities like fibroids

• A tissue sample of the lining of the uterus (endometrial biopsy) to make sure you do not have cancer

Your provider may also recommend taking these medications before the procedure:

• Hormones to thin the lining of your uterus, making it easier to do the ablation 

• Medication to soften your cervix (the opening of the uterus), making it easier to pass the ablation device into the uterus

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There are different devices that can be used to perform an ablation. These devices use heat, cold, or a special kind of electrical energy (electrosurgery) to scar the lining of your uterus. Your provider will discuss which option is best for you.  

During the procedure, your provider inserts the ablation device through your cervix, into the uterus. Several passes of the device along the inner wall of the uterus cause scarring of the endometrium. If your provider uses an electrosurgery device, they will also use a small camera, called a hysteroscope, and fluid to expand your uterus. 

Ablation does not involve incisions or removal of the uterus. It does not affect your hormone levels.

Depending on which device is used, you may be able to have the procedure in an outpatient surgery center or in your provider’s office. In almost all cases, you can go home the same day. 

Does it hurt?

You can expect some cramping, similar to menstrual cramps. To help minimize the discomfort, your provider may give you pain medication about an hour before the procedure. In addition, you will be given some form of anesthesia to numb the area or will be put to sleep, depending on which ablation device is being used. The immediate cramping from the procedure may continue for about 1 to 2 hours after the procedure.

How long is the recovery after uterine ablation?

You can expect on-and-off cramping for 1 to 2 days after the procedure. Typically, over-the-counter NSAIDs, such as ibuprofen, can help with the discomfort. Other treatments for menstrual cramps, like using a heating pad, may help, too. You may also have light vaginal bleeding or a pink discharge for a few days. In general, you can expect to get back to normal activities in 2 to 3 days after the procedure. 

Will my period come back?

Yes, most likely. You may have irregular periods immediately after the procedure, as it may take several months to see the full effect of the ablation. Usually, you can expect to have lighter periods in about 2 to 3 months. You may even stop having periods completely.  But, remember that the goal of the ablation is to lessen the flow of your period, not stop it.

Are there any side effects?

Major complications are rare with uterine ablation, but it’s important to know about them. There is a small risk of the following complications:

• Perforation, or when the device goes through the wall of the uterus (which can injure the bladder or bowel)

• Hemorrhage, or heavy bleeding

• Infection

• Fluid that is used to expand the uterus getting into your pelvic cavity and causing problems

Signs and symptoms of an infection or other possible complications include:

• Fever

• Worsening abdominal pain after the first few days of cramping

• Increased bleeding after the first few days

• Changes in the smell of vaginal discharge

• Nausea and vomiting

• Trouble urinating

If you experience any of these symptoms, you should let your provider know.

Can I get pregnant after ablation?

Yes. Uterine ablation does not prevent future pregnancy, but scarring from the procedure can make pregnancy dangerous. Because of this, you will still need to use some form of contraception to keep from getting pregnant.

What if my periods get heavy again?

Most people who have uterine ablation are very satisfied with the results. But for some, heavy bleeding comes back. In these cases, additional treatment options are available. It may make sense to try hormone medications first, then, if that doesn’t work, a second ablation procedure or a hysterectomy may be recommended. About 1 in 6 women has an additional procedure after a uterine ablation.

Why trust our experts?

Written by:

Andrea Kemp, MD, MPH

Dr. Kemp is an accomplished board-certified physician with over 25 years of clinical experience. She completed medical school and residency training in obstetrics and gynecology in Cincinnati, Ohio.

Edited by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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