Endometrial Ablation Does Not Worsen Endometriosis, But Is Not Indicated for Endometriosis Treatment
Endometrial ablation does not make endometriosis worse because these are fundamentally different conditions affecting different anatomical locations—endometrial ablation treats the uterine lining while endometriosis involves ectopic endometrial tissue outside the uterus. However, endometrial ablation is not a treatment for endometriosis and should not be performed in patients with reproductive-age endometriosis who may desire future fertility.
Understanding the Distinction Between Conditions
Endometriosis involves endometrial tissue implanted outside the uterine cavity (on peritoneal surfaces, ovaries, fallopian tubes, and other pelvic structures), while endometrial ablation destroys only the endometrial lining within the uterus 1.
Endometrial ablation has no direct effect on endometriotic lesions located outside the uterus, as the procedure only addresses intrauterine pathology 2.
The depth of endometriosis lesions correlates with pain severity, and these lesions are not affected by ablating the endometrial cavity 2.
Why Endometrial Ablation Is Inappropriate for Endometriosis Patients
Endometrial ablation is indicated for abnormal uterine bleeding, not for endometriosis-related pain or symptoms 2.
The procedure should only be performed in patients who do not desire future pregnancy, as it carries serious pregnancy-related risks including ectopic pregnancy, preterm delivery, stillbirth, and placental complications 2, 3, 4.
In reproductive-age women with endometriosis, fertility preservation is often a key concern, making endometrial ablation contraindicated 2.
Appropriate Management of Endometriosis
Initial medical management includes NSAIDs, combined oral contraceptives, progestin-only contraceptives, or GnRH agonists for pain control 2, 1.
Laparoscopic excision is superior to ablation for endometriosis treatment, particularly for deep dyspareunia, with significantly better outcomes at 5-year follow-up (p=0.007) 5.
Surgical excision provides improvement across all symptom measures (28-46% improvement) compared to ablation of endometriotic lesions, which shows minimal benefit 6.
For severe endometriosis with anatomic distortion, medical treatment alone may be insufficient, and surgical excision or definitive hysterectomy with bilateral salpingo-oophorectomy may be required 2.
Critical Pitfalls to Avoid
Do not confuse endometrial ablation (treatment for abnormal uterine bleeding) with ablation of endometriotic lesions (a surgical technique for treating endometriosis implants) 5, 6.
Endometrial ablation can mask future endometrial pathology, including cancer, making diagnosis more difficult and delaying treatment 2, 7.
Post-ablation complications include hematometra, cervical stenosis, and post-ablation syndrome, which can cause chronic pelvic pain that may be confused with endometriosis symptoms 2, 7.
Approximately 20-25% of patients experience symptom recurrence within 5-7 years after endometrial ablation, potentially requiring hysterectomy 2, 8.