DEAR MAYO CLINIC: What are the risks of endometrial ablation? I’ve read that the younger you are when it’s done, the more likely it is to cause issues down the road. I’m 31, and my doctor told me I’m a candidate for the procedure due to heavy menstrual bleeding. But should I wait to have it done?
ANSWER: Endometrial 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 isn’t right for you, other options are available to treat heavy menstrual bleeding.
During your period, your body sheds the lining of your uterus, called the “endometrium.” 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.
Endometrial 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.
One consequence 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.
If abnormal bleeding or persistent pain is a concern after endometrial ablation, surgical removal of the uterus — a hysterectomy — 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.
For younger 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. — Dr. Matthew Hopkins, Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota