Some women undergo a procedure called endometrial ablation to manage heavy menstrual periods. Since the procedure affects the condition of the uterus, some wonder if they should be concerned about pregnancy after an ablation. And if pregnancy occurs, what are the risks?
Pregnancy after endometrial ablation is rare but possible. If pregnancy does occur, there is an increased risk of complications. If your healthcare provider has recommended the procedure, it is important to take your family planning concerns into consideration and learn more about the possibility of pregnancy after ablation.
What is Endometrial Ablation?
Endometrial ablation is a minimally invasive procedure that destroys (ablates) the tissue in the lining of the uterus (endometrium). This tissue is often the cause of heavy menstrual bleeding, so destroying it can help relieve some menstrual issues. But the procedure can also impact pregnancy.
According to the American College of Obstetricians and Gynecologists (ACOG), people who are considering undergoing endometrial ablation should be informed of the complications that may occur in any future pregnancy and counseled on the importance of using reliable birth control until after menopause.
How Endometrial Ablation Is Performed
Several different methods can be used to destroy the uterine lining, including:
- Endometrial ablation reduces or stops menstrual bleeding. Pregnancy is rare after an ablation procedure. This is because the uterine lining, where the fertilized egg implants, has been removed and may cause uterine scarring or an abnormally thin uterine lining.
- Freezing. A thin probe, guided by ultrasound, freezes the uterine lining.
- Heated fluid. Heated fluid is inserted into the uterus via a balloon or a special probe.
- Microwave energy. A probe that sends microwave energy (heat) is inserted into the uterus through the cervix.
- Radiofrequency. A probe inserted into the uterus via the cervix sends radiofrequency energy and heat to the lining.
Who Might Get an Ablation?
The decision to get an endometrial ablation is personal and should be made after discussing the benefits and risks with your healthcare provider. According to the Mayo Clinic, endometrial ablations are usually recommended for people who:
- Have unusually heavy periods, soaking a pad or tampon every 2 hours or less
- Have long menstrual periods that last more than 8 days
- Are anemic due to excessive blood loss during menstruation
- Do not wish to get pregnant
Who Should Not Get an Ablation?
You should not get an ablation if you:
- Want to get pregnant in the future
- Have gone through menopause
- Have an active uterine infection
- Have uterine cancer or an increased risk of uterine cancer
Risks of Pregnancy After Ablation
People who have had an endometrial ablation still have their reproductive organs, including ovaries and uterus. Pregnancy after endometrial ablation is rare, occurring in an estimated 0.24-5.2% of people who have undergone the procedure.
Though the chances of getting pregnant after an endometrial ablation are low, it is important that anyone who undergoes the procedure uses a reliable form of birth control (contraceptives).
If pregnancy does occur, these conditions may result.
If conception occurs, the fertilized egg has a lower chance of implanting into the uterus after endometrial ablation. This is because the procedure has destroyed the inner lining of the uterus, which a fertilized egg would normally attach itself to in order to grow into an embryo and eventually a fetus. If the fertilized egg implants into scarred or thinned uterine lining, implantation may be abnormal and may lead to miscarriage or complications later in pregnancy.
If conception and implantation occur, the pregnancy is at serious risk of potential complications. One study published in the International Journal of Obstetrics & Gynaecology found that 85% of pregnancies post-ablation end in miscarriage, termination, or were ectopic (implantation occurred outside of the uterus). The pregnancies that continued had high rates of complications.
Other Pregnancy Complications
Research shows that pregnancy following endometrial ablation comes at a significantly high rate of complications, such as:
- Abnormal uterine bleeding early or later in the pregnancy
- Cesarean section
- Early miscarriage
- Intrauterine growth restriction (IUGR). Can stunt a baby's growth and development in utero due to a lack of oxygen and nutrients in utero. IUGR also increases the risk of preterm labor and the risk of infection for both the baby and the parent after birth.
- Placental abruption. Occurs when the placenta separates from the uterine lining prematurely during pregnancy.
- Placental accreta. Occurs when the placenta grows through or into the uterine wall. This may cause hemorrhage (heavy bleeding) and require an emergency hysterectomy to save the birthing parent's life.
- Preterm labor
Due to the increased risk of potentially life-threatening complications, it is not recommended to get pregnant after endometrial ablation. If you get pregnant after an endometrial ablation, talk to your healthcare provider. Your pregnancy will be considered high-risk, and your healthcare will closely monitor you and your baby's health throughout the pregnancy.
How to Prevent Pregnancy After Endometrial Ablation
Experts strongly recommend against getting pregnant after you've had an endometrial ablation, due to the risks and potentially life-threatening complications to both you and your baby. Using a reliable form of birth control is essential for your health. Forms of birth control to consider after an ablation procedure include:
- Depo-Provera injection
- Intrauterine devices (IUD)
- Oral contraceptives
- Tubal ligation (tubes tied)
The decision to have an endometrial ablation is highly personal and one that should be made with full awareness of the potential health consequences. Be sure to talk to your healthcare provider about any questions or concerns that you have. An endometrial ablation is only a good option for people who know with certainty that they do not wish to get pregnant in the future. Take some time to weigh your options to make the best decision for you.