Pregnancy Risks After Endometrial Ablation

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Endometrial ablation is a treatment for heavy menstrual bleeding. It is an outpatient procedure, which does not require hospitalization. An ablation is one alternative to hysterectomy, for women who prefer not to have major surgery.

The procedure causes scarring of the endometrial lining. The scarring is what reduces or prevents further uterine bleeding. Most women have very little menstrual bleeding, if any after the procedure.

An endometrial ablation is not recommended for any women who are considering, or worried about future fertility. The success rate of ablations are high, but cannot be considered a proper form of birth control. There are severe risks associated with becoming pregnant, for both mom and baby, after an ablation.

History

Women may opt for endometrial ablation if they suffer from excessive heavy menstrual bleeding. Many women with heavy periods experience anemia—iron-poor blood. Anemia will cause people to feel extremely tired all the time, and have low energy levels.

The endometrium functions as a lining for the uterus and is responsible for maintaining a healthy uterus. According to Women's Health.gov, during a woman’s menstrual cycle, the endometrium grows thicker with rich blood vessels. This occurrence offers the perfect environment for implantation of a fertilized egg. If a woman’s body does not have a fertilized egg and implantation, the uterus will shed the endometrial lining. The shedding causes the menstrual period to begin. Each cycle the same process occurs over a twenty-eight day period of time.

The ablation will destroy the endometrial tissue, lining that is responsible for menstrual bleeding. After an ablation, the lining is scarred, so there's no menstrual period or very little if the scarring is less.

Significance

A pregnancy occurs once the fertilized egg implants itself into the endometrial lining of the uterus. The placenta begins to develop once implanted into the endometrium. The placenta is the sole means of nutrition and oxygen to the fetus. The placenta requires a healthy, blood enriched endometrial lining for proper fetal growth and development.

Since after an ablation the endometrial lining is destroyed, it can't grow a healthy lining for a pregnancy.

Effect on Pregnancy

After an ablation, the endometrium is removed, or destroyed and unable to provide the proper nutrients, oxygen or safe environment for the fetus. A pregnancy cannot survive without a viable endometrial lining. There is a 0.7 percent chance of pregnancy after endometrial destruction according to studies by various Departments of Obstetrics and Gynecology.

A woman should discuss all alternatives available, for heavy menstrual bleeding. If there is any concern, or desire, for pregnancy in the future medical professionals would not recommend an ablation.

Warning

Researchers at the Department of Obstetrics and Gynecology, University of Michigan, have documented the rarity of a pregnancy surviving to delivery. There was a documented case that a pregnancy was delivered at 35 weeks gestation back in 2004.

A 2005 study in the United Kingdom documented 70 pregnancies occurring after an endometrial ablation. Thirty-one pregnancies resulted in delivery, however, not without various complications. Premature deliveries occurred in 42 percent of these patients. Difficult deliveries were reported, as the placenta and newborn, were in difficult positions for normal vaginal delivery. The malpresentations resulted in a higher number of cesarean section deliveries. Difficulty with placentas adhering to the uterine wall, and making delivery difficult resulted in 26 percent of cases. There was a fetal mortality rate of 12.9 percent. Most fetal losses were the result of problems with the umbilical cord or the placenta.

Expert Insight

Dr. Paul D. Indman, from Advanced Gynecology in California, is highly recognized for the study and treatment of uterine ablations. He reports that endometrial ablation has gained more popularity as an alternative to hysterectomy for treatment of heavy menstrual bleeding. Pregnancy after endometrial ablation is rare but still possible. The risks of complications have been documented. Physicians should counsel their patients appropriately that pregnancy prevention after endometrial ablation is important. The risks of complications during pregnancy must be addressed as well.

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