Charting after Uterine Ablation

September 19, 2022 Response by  

Question

Can a client still chart after an uterine ablation for excessive bleeding? She is pre -menopause and would like to be able to chart but may need this surgery since she has become anemic from heavy bleeding.

California NFP Teacher

Answer

Dear NFP Teacher,

Charting cycles depends on biomarkers such as cervical mucus, cycle length and temperature. An endometrial ablation destroys the uterine lining by freezing, radio frequency waves, high temperature, or removal of the lining, but typically leaves the mucus glands of the cervix, hormones and ovaries intact so that these biomarkers can mostly still be used for charting.

The usual recommendation is to use contraception or sterilization to avoid pregnancy after an ablation. This is because an ablation does not completely eliminate pregnancy, although it markedly reduces fertility. But when pregnancy does occur after an ablation, it is very high risk because only a very small portion of the uterine lining is left to nourish the unborn baby, who then my suffer intrauterine growth restriction or death.

Because of the chance of very high risk pregnancy, it is not only possible and desirable to chart, but extremely important to chart, in order to avoid this situation. After ablation, there are typically much lighter periods or absent periods, so charting might be more challenging.

Because of the risk of high risk pregnancies, and very low probability of a normal outcome should a pregnancy occur, some gynecologists would recommend hysterectomy over ablation if hormonal therapy cannot resolve bleeding. These days with minimally invasive surgery hysterectomy can usually be done as an outpatient surgery or one night stay, with very short recovery time.

Mary Davenport, MD