Heavy menstruation (heavy enough to require a tampon or pad change almost hourly) is an issue that affects many women at some point throughout their lives, whether they are 20 or 50 years old. There can be numerous causes for this, but doctors don’t often identify the problem, much less figure out a solution. There is a procedure called endometrial ablation that can be done to help reduce a heavy flow, but should you consider it?

Mache Siebel, MD, one of America’s leading experts on women’s health and menopause, thinks endometrial ablation should not be thought of as a first or even a second choice, but rather the last choice. If other treatments such as medication are not proving effective enough, that’s when you should consider undergoing the procedure.

What is Endometrial Ablation?

There are two parts to the uterus: the outer muscle, and the inner lining. This inner lining is built up during the month, and if you aren’t pregnant, sheds with menstruation. Abnormal bleeding could be a nuisance, but other times can also be a sign of medical problems.

Endometrial ablation is the surgical destruction of the inner lining through the use of heat, laser, or other available methods. The procedure involves dilating and stretching the opening of the uterus, called the cervix. Fluid (salt water is most common) is then injected, magnifying everything to make it easier for the doctor to see. Finally, the lining is destroyed.

Before you consider undergoing the procedure, make sure you visit a specialist to check the lining and make sure it’s not bleeding from another cause such as a polyp, cancer, or an irregular lining.

Is It Worth It?

Dr. Siebel believes it’s important to weight the benefits with the risks, which can include the following:

• You should not do the procedure if you still want to get pregnant, as endometrial ablation will impact that opportunity.
• Some women do not have smooth linings, or may have a different contour. Having the procedure done on an irregularly shaped lining may not allow it to be completely destroyed.
• During endometrial ablation, you are also at risk for having a hole punctured through the uterus and into the bladder or intestine, especially if the lining is too thin.
• Very rarely, the solution used to distend and magnify can get into the blood stream and around the heart, causing serious complications to the heart and lungs.
• Lastly, not having all of the lining destroyed in one visit could mean a repeat procedure. This would allow you to still get pregnant, but leave no room for the placenta which could cause serious problems.

After the procedure, side effects could include cramping, nausea, watery discharged mixed with blood, or frequent urination.

If heavy menstruation is truly an issue that has no solution in sight, it is up to you to consider endometrial ablation. Speaking with your doctor and closely examining your lining’s current condition may help give you a clearer picture; but the procedure should only be considered as a last resort after all other options have failed.

In the accompanying audio segment, Mache Seibel, MD, discusses endometrial ablation, if there are any risks to the procedure, and what you can expect after you have the surgery.