Endometrial Ablation: Letting the Lining Go
Endometrial ablation sounds deceptively simple: burn the lining, stop the bleeding, move on with your life.
And for the right person, that can be true.
But ablation is also one of the most misunderstood procedures in gynecology — often oversold, sometimes regretted, and frequently confused with a cure for things it was never meant to treat.
So let’s slow it down and talk about what endometrial ablation actually does, who it’s for, and just as importantly, who it’s not for.
What Is Endometrial Ablation?
Endometrial ablation is a procedure that destroys the lining of the uterus (the endometrium) in order to reduce or stop menstrual bleeding.
The goal isn't to remove the uterus — it's to permanently damage the tissue that builds up and sheds each month. Once that lining is gone, it usually does not grow back in a predictable or healthy way.
This permanence is the most important thing to understand going in.
How Is Endometrial Ablation Performed?
Endometrial ablation can be done using several different techniques. While the tools differ, the goal is always the same: to destroy the uterine lining.
The most commonly used method today is radiofrequency ablation (such as NovaSure), where a mesh device is placed inside the uterus and delivers controlled energy to match the shape of the cavity.
Other methods still used include:
- Heated fluid (thermal balloon)
- Freezing (cryoablation)
- Direct cauterization of the lining during hysteroscopy (rollerball technique)
Regardless of method, ablation does not guarantee complete or uniform destruction of all endometrial tissue — and that limitation matters.
Who Is Endometrial Ablation Best For?
Endometrial ablation is best suited for people who:
- Have heavy menstrual bleeding
- Have completed childbearing
- Do not have significant structural disease inside the uterus
When it works well, people may experience:
- Lighter periods
- Much shorter periods
- Or no periods at all
But “no periods” is not guaranteed — and that distinction matters.
What Ablation Does Not Treat
This is where expectations often go wrong.
Endometrial ablation does not reliably treat:
- Pelvic pain
- Endometriosis
- Adenomyosis
- Fibroids that distort the uterine cavity
- Hormonal cycle symptoms (PMS, ovulation pain, migraines, etc.)
If bleeding is not the main problem — or if pain is the dominant symptom — ablation is often the wrong tool.
Burning the lining doesn’t fix disease deeper in the muscle of the uterus or outside of it.
Endometrial Ablation and Fertility: A Hard Stop
Endometrial ablation is not birth control — but pregnancy after ablation is strongly discouraged.
While pregnancy is unlikely to occur after an ablation, it can still happen, and when it does, it carries a high risk of serious complications, including:
- Miscarriage
- Ectopic pregnancy
- Placental abnormalities
After ablation, the uterine lining is unpredictable and often unsafe for implantation.
For this reason:
- Ablation is only recommended for people who are done with childbearing
- Reliable contraception is still required afterward
This point is critical and often under-emphasized.
How Effective Is Endometrial Ablation?
Effectiveness depends on:
- Age
- Uterine anatomy
- Underlying diagnosis
- Expectations going in
On average:
- Most people have improvement in bleeding
- About 30–50% stop having periods altogether
- A significant number still have lighter but regular cycles
Importantly, ablation is not permanent for everyone. Over time, the uterine lining can partially regenerate — especially in younger patients.
Pain, Regret, and Why Some People Feel Worse After Ablation
One of the more difficult outcomes to talk about is post-ablation pain.
Ablation does not always destroy all endometrial tissue. If any lining remains:
- It can still respond to hormones
- It can still bleed
- But scarring from the procedure can trap that blood
This can lead to significant cyclic pain.
This risk is higher in people who have had a prior tubal ligation, a pattern sometimes referred to as post-ablation tubal sterilization syndrome.
Because of these issues, a meaningful number of people who undergo ablation eventually require hysterectomy to address ongoing pain or bleeding.
The Cancer Detection Problem
One of the most important long-term concerns after endometrial ablation is how difficult it becomes to evaluate abnormal bleeding later.
Ablation often scars:
- The uterine cavity
- Sometimes even the cervical canal
If someone later develops abnormal or postmenopausal bleeding:
- Office endometrial biopsy may be impossible
- Imaging can be limited
- Evaluation often requires hysteroscopy in the operating room
- Even then, complete assessment may not be possible
This is frustrating for patients and providers alike.
For people with higher future risk of endometrial cancer — such as those with obesity, chronic anovulation, PCOS, diabetes, or prolonged unopposed estrogen exposure — ablation is often not the best choice.
Ablation vs. Other Options
Before choosing ablation, it’s worth discussing:
- Hormonal medications
- Hormonal IUDs
- Treating underlying conditions directly
- Or, for some people, hysterectomy
Ablation sits in a narrow middle space: more aggressive than medication, less definitive than hysterectomy.
That doesn’t make it bad — it just makes patient selection critical.
So Why Do People Still Choose Endometrial Ablation?
Despite the downsides, ablation can be the right option for some people.
Potential benefits include:
- No incisions
- Short procedure time
- Fast recovery
- Avoidance of major surgery
- For some, long-term resolution of bleeding
For carefully selected patients who primarily want bleeding control and understand the trade-offs, ablation can be a reasonable choice.
The key is selection, counseling, and expectations.
Bottom Line
Endometrial ablation isn’t inherently “bad.” But it is permanent, limiting, and not reversible.
For the right person, it can be life-changing in a good way. For the wrong person, it can lead to pain, frustration, and more surgery.
Letting the lining go should only happen with full understanding of what comes next.
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