Endometrial Ablation and Adenomyosis: Why It Can Make Pain Worse

Endometrial ablation is a treatment often offered to people struggling with very heavy periods. The procedure uses heat, lasers, or other types of energy to burn away the lining of the uterus, with the goal of reducing or even stopping bleeding. This works well for some patients. In fact, studies show it can control bleeding in about 90 percent of patients. But when it comes to adenomyosis, ablation is not only ineffective, it can sometimes make symptoms worse.

Adenomyosis happens when glandular endometrial tissue migrates into the muscle layer. Instead of sitting on the surface where it can be removed or treated, the tissue is buried deep inside. Endometrial ablation can only reach about 4 to 9 millimetres into the uterus, while adenomyosis often extends 12 millimetres or more. This means the disease is left behind and in some cases, trapped glands become sealed into the muscle, leading to more pain and bloating after the procedure.

Research supports this. In one study, 43 percent of women who needed a hysterectomy after a failed ablation were found to have adenomyosis. Another review published in Obstetrics & Gynecology highlighted that people with both heavy bleeding and painful periods are more likely to see ablation fail. The review also pointed out that conditions like adenomyosis and endometriosis are often missed on standard ultrasounds, meaning some patients are offered ablation without realizing it may not help their underlying condition.

So what are the alternatives? While hysterectomy is sometimes the next step after ablation, it isn’t the only option. Uterine Artery Embolization (UAE), a procedure that blocks blood flow to affected areas of the uterus, has been shown to shrink adenomyosis tissue and improve both bleeding and pain. Importantly, it preserves the uterus, which is an option many people prefer over a hysterectomy.

In Canada, endometrial ablation is still commonly offered to people with heavy bleeding, sometimes even when pain is also a major complaint. However, if adenomyosis or endometriosis is part of the picture, ablation is unlikely to solve the problem and may make things worse. Access to better imaging, like MRI, can help confirm adenomyosis before treatment decisions are made. Canadians should know that options like UAE are available in some centres across the country, though access may depend on region and referral.

For those living with both adenomyosis and endometriosis, awareness is key. Treatments that work for one condition may not help with the other, and ablation is a clear example of a “one-size-fits-all” approach that doesn’t work. At Endometriosis Canada, we believe patients deserve full, honest information about the risks and benefits of every option available, so they can make the choices that are right for them.

💛 Ask about safer options like Uterine Artery Embolization (UAE).

💛 Get the right diagnosis before treatment.

💛 You deserve answers, not more pain.