Clinic: What are the risks of endometrial ablation? Iíve
read that the younger you are when itís done, the more
likely it is to cause issues down the road. Iím 31, and my
doctor told me Iím a candidate for the procedure due to
heavy menstrual bleeding. But should I wait to have it done?
ablation can reduce heavy menstrual bleeding significantly.
But you should consider the potential risks associated with
this procedure. And age can be a factor in how likely you are
to experience problems after endometrial ablation. If you
decide endometrial ablation isnít right for you, other
options are available to treat heavy menstrual bleeding.
period, your body sheds the lining of your uterus, called the
ďendometrium.Ē When periods become unusually heavy on a
regular basis, the condition requires evaluation. In general,
producing enough blood to soak through a pad or tampon every
two hours or less is considered heavy flow.
ablation destroys the uterine lining. Although techniques
vary, the procedure usually is conducted using instruments
that deliver heat or extreme cold to the endometrium. After
endometrial ablation, many women still have periods, but they
are much lighter.
of endometrial ablation is that scar tissue forms within the
uterus after the procedure, changing the structure of the
uterine cavity. Because of that change, if you have abnormal
bleeding after endometrial ablation, including postmenopausal
bleeding, it can be more challenging for your health care
provider to assess the cause of the bleeding and treat it. The
scar tissue also can obstruct menstrual flow. In some cases,
that causes pain.
bleeding or persistent pain is a concern after endometrial
ablation, surgical removal of the uterus ó a hysterectomy
ó may be necessary. There have been multiple studies looking
at predictors of which women are most likely to require a
hysterectomy after endometrial ablation. Although many
predictors have been reported, the most consistent is age.
Research shows endometrial ablation gives predictable results
for the first five to seven years following the procedure.
Rates of hysterectomy trend up after that.
Age plays a
role in that trend because ablation techniques rarely destroy
all of the endometrium, and the endometrium has a tendency to
regenerate prior to menopause. In the U.S., the average age of
menopause is 51. The younger a patient is when she has
endometrial ablation, the longer the endometrium has to grow
back and the more opportunities there are for complications to
arise over the years. When age is the only consideration,
research shows that the ideal ablation candidate generally is
older than 40.
In one Mayo
Clinic study of women who had endometrial ablation, factors
that increased the risk of requiring a hysterectomy after
ablation included being younger than age 45 at the time of
ablation, significant menstrual pain before ablation, and
tubal ligation before ablation. If a woman had all three risk
factors, there was a 50 to 60 percent chance of hysterectomy
within five years of ablation. Conversely, in patients older
than 45 without significant menstrual pain before the
procedure and no history of tubal ligation, only about 5
percent required a hysterectomy within five years of ablation.
You also should
be aware that endometrial ablation is only an option for women
who are done having children. And although pregnancy is not
recommended afterward, ablation cannot be used as a form of
contraception. Pregnancies following endometrial ablation are
high-risk for both the mother and baby.
women who may decide not to have endometrial ablation, there
are other effective treatments to ease heavy menstrual
bleeding, including hormonal medications, birth control pills
and intrauterine devices. Discuss all your options, along with
their risks and benefits, with your health care provider to
decide which choice is best for you.