Although pregnancy is possible after ablation the effects of endometrial ablation on pregnancy can be unpredictable. Most women are advised that they not become pregnant after ablation because of the risks involved.
Endometrial ablation is done to decrease heavy period bleeding. When a woman is bleeding to death from her periods… getting pregnant is often the last thing on her mind. When they are thinking of having an ablation they usually are not considering the fact they may want to become pregnant again in the future.
Doctors understand pregnancy after endometrial ablation is extremely high risk. They know their patients should not become pregnant. Most doctors will not perform an endometrial ablation unless the woman has had a tubal ligation or her partner has had a vasectomy.
Although most women will be satisfied with the decreased vaginal bleeding after their ablation procedures, some women will regret their decision and want to become pregnant again. Some will consider in-vitro fertilization (IVF) while others will consider vasectomy or tubal ligation reversal surgery.
At A Personal Choice in Raleigh North Carolina, we specialize in tubal reversal surgery. We have many patients who have reversal after endometrial ablation and who will successfully become pregnant naturally. We wrote these informative articles about endometrial ablation to better educate our patients.
This article is the second in our series on endometrial ablation and pregnancy.
The first article, Pregnancy After Endometrial Ablation And Tubal Reversal, provided an introduction to endometrial ablation and introduced the possibility of pregnancy after ablation of the endometrium.
This article will explain why endometrial ablations are performed and how the ablation procedure is used to treat heavy menstrual periods.
Heavy Menstrual Periods and Endometrial Ablation
Endometrial ablation procedures are recommended for women who have anemia (low iron) from heavy menstrual periods.
Most commonly women who have ablation procedures have either uterine leiomyomas (fibroids) or hormonal imbalances, which cause heavy menstrual periods. Sometimes women will have a tubal ligation procedure and then develop heavy periods after their tubal ligation.
In many instances these women have menstrual bleeding so heavy that it causes anemia or low iron. These women will have to consider hormonal treatment, endometrial ablation, or hysterectomy. Endometrial ablation provides an effective means to decrease menstrual bleeding, improve anemia, and avoid hysterectomy.
An endometrial ablation can be a very simple procedure that allows you to avoid a major surgical procedure (ie hysterectomy) and prolonged hospitalization. What seems like an easy choice… when you are not thinking about actively becoming pregnant… will seem like a bad choice if you change your mind about becoming pregnant again.
How Endometrial Ablation Works?
Endometrial ablation works by removing the endometrial layer of the uterus. The uterus can be thought of as having two layers: a thick muscular layer (myometrium) and a regenerative lining (endometrium).
The muscular myometrium provides the blood supply to the endometrium, an environment to contain and support a growing pregnancy, and muscular contractions during labor. The endometrium has the ability to regenerate, grow, and shed with every menstrual cycle. When a fertilized egg lands on the endometrium the endometrial lining will support and nurture the early pregnancy.
If the endometrium does not receive an egg then the endomertial lining will shed off as a menstrual period and the cycle starts all over again.
Endometrial ablation techniques use a variety of energy sources to destroy and remove the regenerative cells which create the uterine lining. Our previous article provided a brief overview of the different types of endometrial ablation.
The energy emitted by these devices removes the endometrial layer and destroys the regenerative endometrial cells. This causes a reduction or cessation in the amount of bleeding during the menstrual period. Most endometrial ablation procedures do not remove 100% of the endometrial lining and, if regeneration of the lining occurs, then pregnancy is possible.
You can easily see how damaging or destroying or removing the uterine lining is how endometrial ablation effects pregnancy to make each pregnancy at much higher risk of an adverse outcome.
Risks of Endometrial Ablation
Endometrial ablation is a safe procedure that allows women to avoid removal of the uterus (hysterectomy) and the risks associated with this major procedure. No procedure is entirely without risks and the risks of ablation are:
Puncture of the uterine wall
Injury to the uterus or intestines
Pulmonary edema (fluid buildup in the lungs)
Cervical lacerations
Hematometria (blood build up in the uterus)
Pyometria (pus build up in the uterus)
Intrauterine scarring (Asherman Syndrome)
Pregnancy miscarriage, preterm delivery, and stillbirth
After Endometrial Ablation
Endometrial ablation is safe, effective, and provides high patient satisfaction rates. Despite being very effective, most endometrial ablation techniques will not remove all of the regenerative cells in the endometrium.
It is very common for women to have an endometrial ablation and continue to have periods. In fact about 4 out of 5 women who have endometrial ablation will continue to have periods after their ablation procedures. This is because it is extremely difficult to remove all of the uterine lining.
After endometrial ablation, most women will notice a decrease in the amount of their menstrual bleeding. Some women will continue to have menstrual periods, most women will gradually notice the resumption of menstrual periods over the next several years, and a few women will never have another menstrual period.
Although patient satisfaction rates after endometrial ablation are high, women can have menstrual bleeding return after an endometrial ablation procedure. Some of these women will need additional treatments for their menstrual bleeding.
Endometrial Ablation and Tubal Blockage
Most women will not be able to become pregnant after endometrial ablation because of tubal blockage and impaired endometrial function.
Some women will experience tubal blockage due to the destructive process of endometrial ablation. This tubal blockage will most likely occur at the area where the tube inserts into the uterine cavity. Others will have an inadequate endometrial lining after the ablation. The egg will either have no fertile endometrium to implant on or it will be insufficient to provide the early nurturing and support required by the fertilized egg.
Although endometrial ablation will reduce the menstrual periods of women, the endometrial ablation is not 100% effective at removing all of the regenerative cells of the endometrial lining.
Accidental pregnancies do occur after endometrial ablation and women should not rely on endometrial ablation as a method of permanent birth control.
Endometrial Ablation Effects On Pregnancy
It is recommended that women who have an endometrial ablation should utilize an effective and permanent birth control, such as tubal ligation or vasectomy. Women are advised not to become pregnant after the endometrial ablation because of the effects of endometrial ablation on pregnancy… pregnancies after endometrial ablation are at higher risk of miscarriage, preterm delivery, growth restriction, placental problems, and stillbirth.
Pregnancy After Endometrial Ablation
Accidental and intentional pregnancies do occur after endometrial ablation. Our third article, Tubal Reversal, Endometrial Ablation, Pregnancy: Concerns , will explain for readers why pregnancy may be more difficult after an endometrial ablation procedure.
Readers who are interested in corrective tubal surgery or tubal reversal should visit the website of A Personal Choice or call (919) 977-5050 to speak with a staff member and have their questions answered.
