Endometrial Ablation

What is endometrial ablation?

Endometrial ablation is a safe and effective minimally invasive procedure used to treat abnormal or heavy periods, known to your doctor as “heavy menstrual bleeding” or “menorrhagia”. By destroying the tissue that lines the inside of your uterus (the endometrium) — the same tissue that builds up and sloughs off blood during your period — endometrial ablations can significantly reduce blood loss and relieve painful cramping. Endometrial ablations can provide a higher quality of life to those who suffer from heavy periods, helping women get back to the activities they enjoy without worrying about leaking through their clothes, severe menstrual cramping, and other side effects of heavy periods.

Why would I need an endometrial ablation?

Endometrial ablations treat the blood loss associated with heavy periods, and may improve pain and other PMS symptoms. Ablation is a great treatment option for women who have previously tried and discontinued medical therapy — hormone-based medications like a birth control pill, intrauterine device (IUD), arm implant, etc — due to problematic side effects or for those who cannot or do not want to take hormonal birth control. Endometrial ablations are a more conservative and less invasive procedure than a hysterectomy (the removal of the uterus), offering a less disruptive treatment experience with fewer risks and faster recovery times. It’s important to note, however, that a hysterectomy is the only treatment guaranteed to stop your period altogether. Instead, endometrial ablations aim to reduce excessive bleeding to restore a lighter or more normal period.

What happens during endometrial ablation?

Endometrial ablations can be performed either in the office or in an outpatient setting, such as a hospital or surgery center. If you receive treatment in your gynecologist’s office, the procedure will be performed while you lie on the exam table. For traditional heat-based ablations, you will receive IV sedation or general anesthesia before the treatment begins. If your doctor uses cryotherapy, you will have the option to choose a less extensive pain control method, like over-the-counter or prescription pain medications or anxiety medications. If you receive treatment in a hospital or surgery center, you will arrive early and get set up with an IV for sedation during the procedure.

During the procedure, your gynecologist will place a probe into your uterus to administer either heat-based or cold-based energy to destroy the endometrium. While each procedure varies based on each patient’s needs and the chosen technique, the ablation treatment itself is completed within minutes.

Who shouldn’t get an endometrial ablation?

Many women are good candidates, but there are certain factors that can lower your chances of a satisfactory treatment outcome or increase your risk of developing other conditions, especially with traditional ablation techniques. Including:

Contraindications

Plans for pregnancy
After your ablation, you must continue taking contraception until you begin menopause. It is possible to become pregnant after endometrial ablation, but the pregnancy would have very high risks and potentially negative outcomes for both the mother and baby.
Uterine abnormalities
Endometrial ablation is contraindicated if your uterus has a highly irregular shape or orientation, is weak or infected, or has a physical obstruction such as fibroids, polyps, or a thickened endometrium.
Cancer
If you have cervical or endometrial cancer, more diagnostic testing is needed to determine the proper course of treatment.

Considerations

Age
Endometrial ablation is for premenopausal women who are done having children. While not a strict guideline, research has shown that women over 40 have a lower chance of re-intervention.1
Obesity
Patients who are obese may be at a higher risk of treatment failure with many traditional (heat-based) ablation techniques.2 These women may need further treatment, potentially a hysterectomy, to address abnormal or persistent bleeding.
Prior tubal ligation
With many types of ablation techniques (mainly heat-based ablations), a prior tubal ligation (“getting your tubes tied”) can increase your risk of post-ablation tubal sterilization syndrome (PATSS), which causes severe, chronic pelvic pain.3
What are the different types of ablations?

There are a variety of techniques available for endometrial ablation. Most are heat-based and rely on scarring to indicate a successful treatment, while some techniques use cryotherapy to freeze endometrial tissue.4 Your healthcare provider may recommend any of the following methods:

Cryoablation

Cryoablation uses a freezing agent to gently freeze, dehydrate, and destroy endometrial cells, inducing a different healing response that doesn’t rely on scarring to alleviate symptoms. Results may take 3-6 months before the treatment has its full effect.

Hydrothermal

This method directly applies heated fluid to the endometrium, which can be more effective for those with a slightly misshapen uterus (compared to other techniques that use non-conforming liners), but can also increase the risk of burn injuries.5

Thermal balloon

A small balloon fills up with heated liquid inside the uterus to destroy the endometrium. The balloon can protect against direct heat injury but can also struggle to provide uniform coverage during treatment.6

Microwave

A specific wavelength of electromagnetic energy (microwaves) is administered through a thin probe to heat the endometrium via direct contact. Like hydrothermal ablation, this technique cause unintentional damage to surrounding tissues.7

Radiofrequency

A triangular electrical mesh is used to deliver radiofrequency energy to the endometrial tissue. While the extreme heat effectively destroys tissue, radiofrequency ablations can cause excess scarring and painful adhesions.4

What are the risks of the procedure?

Endometrial ablation is a low-risk treatment but, as with any surgical procedure, it’s important to be aware of the potential risks and complications associated with tissue destruction. These can include:

  • Infection in the ablated endometrium
  • Heavy bleeding post-ablation
  • Uterine perforation
  • Burn injuries to nearby tissues
  • Changes in menstrual patterns

Most women experience a smooth and relatively quick recovery from their endometrial ablation. While serious complications are rare, it’s important to immediately contact your gynecologist if you recognize signs of infection: fever, pus-like vaginal discharge, extreme swelling, and severe pain.

What happens before the procedure?

Your gynecologist will provide step-by-step instructions to prepare for your procedure. These steps will likely include:

  • Start fasting (no eating or drinking) 8 hours before your procedure if you will be sedated.
  • You may be asked to take medication before arrival to prepare your cervix and thin your endometrium.
  • A clinician will verify that you are not pregnant and are not taking medications that could interfere with the procedure or your recovery.
  • You may be asked to take medication to help you relax or an IV to receive pain medication or sedatives.
What should I expect after endometrial ablation?

Overall, you should have a quick and easy recovery from an endometrial ablation procedure. If you are sedated for the procedure, whether it’s in an outpatient setting or in your doctor’s office, you will be closely monitored as you wake up. It can take a couple of hours before you are cleared to go home.8 If you do not receive sedation, as is often the case with cryoablation, you should be able to go home shortly after the procedure is complete.9 It may take a few days to resume your normal daily activities. It’s important to follow your doctor’s orders for optimal healing. This includes taking medications as directed, attending follow-ups, and following specific care instructions. Contact your doctor immediately if you notice signs of infection. Depending on the type of ablation technique that is used, you might experience:

 
A few days of cramping, bleeding, and nausea, as well as a few weeks of watery or bloody discharge. During this time, you may want to wear a sanitary pad.
 
You may need to take over-the-counter pain relievers to help with the discomfort and soreness. Be sure to only take medications that have been approved by your doctor.
 
Your physician may limit the use of tampons, intercourse, or other activities. Follow doctor's orders as prescribed, as each patient's experience may vary.
Why you should consider endometrial ablation with Cerene®

The Cerene Cryotherapy Device is an endometrial cryoablation device that deploys freezing nitrous oxide into an ultra-thin, highly flexible, cavity-conforming liner for a safe, gentle, and uniform ablation treatment. Cerene uses cryotherapy to achieve a unique healing response with minimal scarring, which reduces the risk of long-term post-ablation pain while delivering long-lasting relief from heavy periods. Cerene can be performed in the comfort of your doctor’s office or in an outpatient setting to provide the best possible treatment experience. Learn more about how Cerene restores normal, light, or no periods in 90% of patients† and relieves severe menstrual cramping in 86% of patients.††

Learn About Cerene

† Patient-reported data are 1 year after treatment with durable results at 3 years
†† Improvement reported one year after treatment for patients reporting severe/very severe cramping

 

RESOURCES
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  1. Weiss, C. (2021, September 15). Mayo Clinic Q and A: Endometrial ablation when pelvic pain or endometriosis are present. Mayo Clinic News Network. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-endometrial-ablation-when-pelvic-pain-or-endometriosis-are-present/
  2. Preoperative uterine bleeding pattern and risk of endometrial ablation failure
    Smithling, Katelyn R. et al. American Journal of Obstetrics & Gynecology, Volume 211, Issue 5, 556.e1 – 556.e6
  3. Tam, T., Elgar, C., Jirschele, K., Lombard, E. (2012). Post-ablation tubal sterilization syndrome following NovaSure endometrial ablation: two case reports. Gynecological Surgery 9, 449-452
  4. Wortman M. (2017). Late-onset endometrial ablation failure. Case Reports in Women’s Health, 15, 11–28.
  5. Silwer, J. F., & Falconer, C. (2014). Thermal injury to the sigmoideum following hysteroscopic hydrothermal ablation. Acta obstetricia et gynecologica Scandinavica, 93(2), 220.
  6. Medical Advisory Secretariat (2004). Thermal balloon endometrial ablation for dysfunctional uterine bleeding: an evidence-based analysis. Ontario health technology assessment series, 4(11), 1–89.
  7. MicroCube. (2023). Minitouch 3.8 ERA System: Instructions for Use (PN 5091 Rev A-6, CLEAN VERSION). MicroCube.
  8. Endometrial Ablation. (n.d.). Johns Hopkins Medicine. Retrieved January 10, 2025, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/endometrial-ablation
  9. What to Expect After the Cerene Treatment. (2023, April 12). Cerene. https://cerene.com/what-to-expect-after-the-cerene-treatment/

Important Safety Information

Cerene® Cryotherapy Device is indicated to ablate the endometrial lining of the uterus in premenopausal women with heavy menstrual bleeding due to benign causes for whom childbearing is complete. Pregnancy following the Cerene procedure can be dangerous; therefore, contraception must be used until menopause. The Cerene procedure is not for those who have or suspect uterine cancer; have an active genital, urinary or pelvic infection; or an IUD. There are risks and considerations associated with the use of the Cerene Cryotherapy Device. Temporary side effects may include uterine cramping, vaginal infection, and lightheadedness. For detailed benefit and risk information, consult the Cerene Instructions for Use (IFU) or your healthcare professional. CAUTION: Federal (USA) law restricts this device to sale by or on the order of a physician trained in the use of the Cerene Cryotherapy Device. Learn More