Endometrial Ablation Success Rate and Fibroids: What to Know

Heavy menstrual bleeding can disrupt work, relationships, and quality of life. Endometrial ablation (EA) is a minimally invasive option that can substantially reduce bleeding for people who do not plan future pregnancies. If you also have uterine fibroids, it’s important to understand how they affect candidacy and outcomes. This guide synthesizes evidence from trusted sources including the American College of Obstetricians and Gynecologists (ACOG), the National Institute for Health and Care Excellence (NICE), the U.S. Food and Drug Administration (FDA), and Cochrane reviews.

What is endometrial ablation?

Endometrial ablation destroys the lining of the uterus (endometrium) using energy sources such as radiofrequency, heated fluid, freezing, or microwave. The goal is to reduce or stop menstrual bleeding. It is intended for those who have completed childbearing. Pregnancy can still occur after ablation and is high risk; reliable contraception or sterilization is strongly recommended afterward (ACOG).

How is “success” measured?

Success after endometrial ablation is typically defined by:

• Reduction in bleeding to normal or less (many trials call this “treatment success”).
• Amenorrhea (no periods) — a desirable but not guaranteed outcome.
• Patient satisfaction and avoidance of further surgery (no repeat ablation or hysterectomy).

What do the numbers show?

Outcomes vary by device, age, uterine anatomy, and underlying conditions like fibroids or adenomyosis. Across modern “global” ablation techniques (radiofrequency, thermal balloon, hydrothermal, cryo):

• Bleeding reduction to normal or less: Approximately 70–90% at 12 months in clinical studies of second-generation devices (FDA summaries; ACOG patient guidance).
• Amenorrhea: Roughly 20–45% at 1 year, with some radiofrequency systems reporting rates in the mid-30% range in pivotal trials (FDA). Amenorrhea is more likely in people over 45.
• Satisfaction: Commonly >80% at 1–3 years in trials.
• Need for additional surgery: About 15–25% undergo further procedures (often hysterectomy) within 5–10 years, with higher rates among those who are younger, have significant fibroids or adenomyosis, or have severe menstrual pain (Cochrane reviews; ACOG).

These ranges reflect a mix of devices and study designs; your individual probability depends on your anatomy and goals.

How do fibroids affect success rate?

Fibroids (uterine leiomyomas) are a common cause of heavy bleeding. Their size and location matter for ablation:

• Small fibroids not distorting the cavity: NICE recommends considering endometrial ablation for people with a normal uterine cavity or small fibroids (typically less than 3 cm) that do not significantly distort the cavity.
• Submucosal fibroids (inside the cavity): These often cause heavy bleeding and can interfere with uniform ablation. Guidelines suggest removing cavity-distorting submucosal fibroids hysteroscopically before (or instead of) ablation to improve outcomes (NICE, ACOG).
• Intramural or large fibroids: Fibroids embedded in the uterine wall or larger than about 3 cm are associated with lower ablation success, higher risk of persistent symptoms, and greater likelihood of additional surgery. In many cases, myomectomy, uterine artery embolization (UAE), or hysterectomy are more effective options for symptom control.

In short, ablation treats the lining, not the fibroid itself. When fibroids are a major driver of symptoms—especially if they distort the uterine cavity—addressing the fibroid is often necessary to achieve the best outcome.

Who is a good candidate?

According to ACOG and NICE, ideal candidates typically have:

• Heavy menstrual bleeding with a normal uterine cavity or only small, non–cavity-distorting fibroids.
• No desire for future pregnancy, and willingness to use reliable contraception afterward.
• No evidence of endometrial hyperplasia or cancer (evaluation may include ultrasound and endometrial biopsy based on age and risk factors).
• No active pelvic infection, recent pregnancy, or retained intrauterine device.

People with suspected adenomyosis or significant menstrual pain may have lower satisfaction after ablation and higher reintervention rates.

Safety profile and recovery

Endometrial ablation is usually an outpatient procedure with a brief recovery. Common short-term effects include cramping and watery discharge. Rare but serious complications include uterine perforation, infection, bleeding, or thermal injury to surrounding organs. People with prior tubal sterilization can develop a rare delayed pain condition called postablation tubal sterilization syndrome (PATSS). Discuss your individual risks with your clinician (ACOG; FDA device labeling).

If you have fibroids, consider these alternatives

• Levonorgestrel intrauterine system (LNG-IUS): Highly effective for heavy bleeding and often first-line in guidelines; may be limited by cavity distortion from fibroids (NICE, ACOG).
• Medications: Tranexamic acid, NSAIDs, combined hormonal contraception, or progestins can reduce bleeding. Short-term use of GnRH agonists or oral GnRH antagonists with add-back therapy can shrink fibroids and bleeding while on therapy (FDA-approved antagonists include relugolix combination therapy and elagolix combination therapy).
• Hysteroscopic myomectomy: Removes submucosal fibroids and can be combined with or followed by ablation when appropriate.
• Uterine artery embolization (UAE): Minimally invasive option that shrinks fibroids by blocking their blood supply; preserves the uterus but is not recommended for future fertility.
• Myomectomy: Surgical removal of fibroids; preferred for those seeking to preserve fertility when feasible.
• Hysterectomy: Definitive treatment that eliminates bleeding and fibroid-related bulk symptoms; higher surgical risk and recovery compared with ablation.

Questions to ask your clinician

• Based on my imaging, do I have submucosal or intramural fibroids, and how large are they?
• Would hysteroscopic myomectomy or another fibroid-directed treatment be a better first step than ablation?
• Which ablation device do you use, and what are your practice’s amenorrhea and reintervention rates?
• What is my individualized risk of needing repeat surgery or hysterectomy within 5–10 years?
• What contraception will I use after ablation?

Bottom line

Endometrial ablation can markedly reduce heavy menstrual bleeding, with about 70–90% achieving normal-or-less bleeding at 1 year and roughly 20–45% experiencing no periods, depending on the device and patient factors. Fibroids—especially those that distort the uterine cavity or are larger than about 3 cm—lower the chance of success and increase the likelihood of further treatment. Careful evaluation of fibroid size and location, plus discussion of alternatives such as LNG-IUS, myomectomy, UAE, or hysterectomy, will help you choose the most effective and durable approach for your goals.

Sources and guidance: ACOG Patient FAQ on Endometrial Ablation (acog.org); NICE Guideline NG88: Heavy Menstrual Bleeding (nice.org.uk); FDA device summaries for endometrial ablation systems; Cochrane reviews comparing endometrial ablation/resection with hysterectomy and medical therapy. These organizations regularly update guidance; consult your clinician for personalized recommendations.