Endometrial Ablation Surgery and Fibroids: What to Know

September 13, 2025

Endometrial Ablation Surgery and Fibroids: What to Know

Heavy menstrual bleeding can be life-disrupting, and uterine fibroids are one of the most common causes. Endometrial ablation is a minimally invasive procedure designed to reduce bleeding by treating the uterine lining. But how well does it work if you also have fibroids? Below, we explain when ablation helps, when it doesn’t, safety considerations, and the alternatives—using evidence and guidance from trusted medical sources.

What is endometrial ablation?

Endometrial ablation (EA) removes or destroys the endometrium—the tissue that lines the uterus—to reduce or stop menstrual bleeding. It is typically offered to people who have completed childbearing and have heavy menstrual bleeding (HMB) not controlled by medications. EA is performed with devices that use heat, cold, radiofrequency, microwave, or circulating heated fluid to treat the lining. Most procedures take less than 30 minutes and can be done in an outpatient setting.

Key points:

Goal: Reduce bleeding; some patients stop bleeding entirely (amenorrhea).
Contraception is still needed after EA; pregnancy can occur but is unsafe and high risk after ablation.
Pre-procedure evaluation usually includes imaging and an endometrial biopsy to rule out cancer or precancer.

Sources: ACOG; MedlinePlus; FDA.

How do fibroids affect the success of ablation?

Uterine fibroids (leiomyomas) are benign muscle tumors that can cause heavy bleeding, pelvic pressure, anemia, and reproductive issues. Whether EA helps depends on the type, size, and location of fibroids:

Best candidates: Small fibroids that do not significantly distort the uterine cavity. In these cases, EA can meaningfully reduce bleeding.
Submucosal fibroids (inside the cavity): Often the main driver of heavy bleeding. Hysteroscopic removal (myomectomy) is usually recommended first. EA may be considered afterward to reduce recurrence of heavy bleeding.
Large or cavity-distorting fibroids: EA is less effective and may be inappropriate because devices cannot uniformly treat the lining.

In real-world studies, 20–50% of patients achieve no or minimal bleeding after EA, and patient satisfaction is high (often 80–90%). However, people with fibroids—especially younger patients and those with larger or cavity-distorting fibroids—are more likely to need additional treatment over time. Reintervention (repeat ablation, uterine artery embolization, or hysterectomy) can occur in up to 20–30% of patients within five years, with higher rates in those with fibroids.

Sources: ACOG; NCBI Bookshelf (StatPearls): Endometrial Ablation; MedlinePlus: Uterine Fibroids.

Who is a good candidate for endometrial ablation?

EA may be appropriate if:

You have heavy menstrual bleeding that affects quality of life.
You have completed childbearing and can use reliable contraception afterward.
Imaging shows a uterine cavity that can be safely treated (typically without large cavity-distorting fibroids).
An endometrial biopsy rules out cancer or precancer (hyperplasia with atypia).

Often, your clinician will order a transvaginal ultrasound and may perform saline infusion sonohysterography or hysteroscopy to map the cavity and identify submucosal fibroids.

When is ablation not recommended?

Desire for future pregnancy (EA is not a fertility-sparing procedure).
Known or suspected endometrial cancer or precancer.
Active pelvic infection.
Postmenopausal bleeding.
Uterine cavity markedly distorted by fibroids or large uterus beyond device specifications.

Sources: ACOG; FDA.

Benefits, limits, and safety considerations

Expected outcomes

Many patients have significant bleeding reduction; some achieve amenorrhea.
Quality of life and anemia often improve when bleeding is controlled.

Limitations with fibroids

EA does not remove fibroids, so bulk symptoms (pressure, urinary frequency, constipation) usually persist.
Higher chance of needing additional procedures in women with fibroids.
Ablation can make future evaluation of the uterine lining more challenging; abnormal bleeding after EA still requires assessment.

Risks

Cramping, discharge, or spotting during recovery.
Infection, uterine perforation, fluid imbalance (rare with modern devices).
Post-ablation tubal sterilization syndrome (cyclic pelvic pain in some patients with prior tubal ligation).
Pregnancy after EA is uncommon but dangerous—risk of miscarriage, abnormal placentation, and preterm birth is high; effective contraception is essential.

Sources: ACOG; FDA; NCBI Bookshelf (StatPearls).

Alternatives for fibroid-related heavy bleeding

Treatment should be individualized based on symptoms, size and location of fibroids, age, and fertility goals.

Medical therapy
- Levonorgestrel intrauterine system (LNG-IUD): reduces bleeding; works best if the cavity is not severely distorted.
- Tranexamic acid: non-hormonal option taken during menses.
- Hormonal therapies: combined oral contraceptives or progestins.
- GnRH antagonists with add-back therapy: FDA-approved options can reduce heavy bleeding from fibroids (e.g., relugolix combination therapy). See FDA approval of Myfembree.
Procedural options
- Hysteroscopic myomectomy: Removes submucosal fibroids inside the cavity; often first-line for heavy bleeding when childbearing is still desired.
- Uterine artery embolization (UAE): Minimally invasive radiology procedure that shrinks fibroids and reduces bleeding and pressure symptoms. See MedlinePlus.
- Myomectomy (laparoscopic/open): Removes fibroids while preserving the uterus—preferred if future pregnancy is desired.
- Hysterectomy: Definitive cure for bleeding and fibroid-related symptoms for those who have completed childbearing.

Preparing for the procedure and recovery

Before ablation

Confirm diagnosis and rule out malignancy with an endometrial biopsy.
Map fibroids with imaging (ultrasound; sometimes saline infusion sonography or MRI).
Discuss contraception plans post-procedure.
Some clinicians may use short-term medication to thin the lining for optimal treatment.

Day of procedure and after

Most patients go home the same day.
Cramping and watery discharge are common for a few days to weeks.
Avoid intercourse, douching, and tampon use as directed (often around 1–2 weeks).
Call your clinician for heavy bleeding, fever, severe pain, or foul-smelling discharge.

Questions to ask your specialist

Are my fibroids distorting the uterine cavity, and how does that affect success with ablation?
Would hysteroscopic myomectomy be better for my type of fibroid?
What are my chances of needing another procedure in the next 3–5 years?
Which contraception should I use after ablation?
What alternatives could address both bleeding and pressure symptoms?

The bottom line

Endometrial ablation can be an effective option to control heavy menstrual bleeding, including in some patients with small, non–cavity-distorting fibroids. When fibroids protrude into or distort the uterine cavity, myomectomy or other targeted treatments usually work better. A careful evaluation with imaging and biopsy—plus a discussion of your goals for fertility and symptom relief—will help you and your clinician choose the safest, most effective path.