Endometrial ablation

What is endometrial ablation?

This is a treatment for heavy periods and is only for women who do not want children (or to have any more children). The operation reduces the heaviness of periods by destroying the lining of the womb using heat (ablation).

During ablation, an instrument is inserted through the cervix into the womb. Once in place, it will deliver heat to the lining of the womb.

The consultant may recommend that the lining of the womb is thinned before the operation as this will help to give a good result. This is done by giving an injection about 3 to 5 weeks before the operation. Your consultant will discuss this with you and may ask your GP to arrange the injection once a date for your operation is known. This injection might stop your period before the operation. During this time you may have irregular bleeding as well as temporary and reversible menopausal symptoms such as hot flushes and night sweats. These symptoms will last no longer than 4 to 6 weeks.

How is the operation performed?

The operation is usually carried out under a general anaesthetic (while you are asleep).

The doctor will stretch open (dilate) the neck of the womb (cervix), and place a telescope into the womb. The womb is then filled with fluid so that the doctor has a clear view. The lining of the womb can then be destroyed by ablation as mentioned earlier on this page. The operation usually takes between 10 and 30 minutes.

Sometimes it will not be possible for the operation to go ahead due to technical reasons; very rarely equipment can fail or it may not be possible to position the equipment correctly.

Possible complications

The majority of ablation operations are very straight forward, but on rare occasions, there can be complications. These include:

Bleeding

Sometimes there can be bleeding during the operation, if this happens, a small tube (catheter) is placed inside the womb for a few hours to stop the bleeding. The catheter is removed before you go home. You will be given fluids via a drip (thin tube) in the back of your hand, this will replace any blood loss.

Perforation

In as few as 1 in 100 patients, the telescope may go through the wall of the womb.

If this happens, the operation would be stopped and you would be observed for any bleeding. Very rarely, we would have to carry out a bigger operation to close the hole. This would involve opening your abdomen and stitching the hole in your womb and would mean a longer stay in the hospital. We must stress again that this is a very rare complication.

Fluid overload

Very rarely, the fluid used to fill the womb can get into your blood stream. If this happens the operation would have to be stopped and medication is given to remove the excess fluid. Again, you would need to stay in the hospital for longer than planned.

Infection

If you get lower abdominal pain and an offensive-smelling vaginal discharge after your operation, you may have an infection in the womb. This will need treatment with antibiotics from your GP.

Important information

You should not have this procedure if there is any chance you would like to become pregnant in the future. If you do become pregnant, this treatment could increase the risk of complications.

The operation itself is not a birth control method, so you will need to continue your contraception afterwards.

Alternative treatments for heavy periods

Hormonal therapy, including the combined contraceptive pill and progesterone pills can regulate and reduce periods.

Tranexamic acid, which is not a hormone, can reduce blood loss and is taken just on the heavy days of the period.

The Mirena® coil is a very popular treatment as it can reduce periods by 75% to 90%. This coil provides contraception and only has to be changed every 5 years.

How successful is this operation?

After endometrial ablation, 40 to 60 in every 100 women have no periods at all. A further 30 to 40 in every 100 continue to have periods that are lighter than before, and around 10 in every 100 women have no change in their periods. The chance of needing another operation, either a repeat ablation or hysterectomy, is about 15 in every 100 cases.

What happens after the operation?

A doctor will talk to you about your operation before you are discharged home. You should be able to go home later the same day unless there have been any complications or you have other health problems, in which case you may need to stay overnight.

You will need a responsible adult to collect you and be with you overnight. You must not drive after having a general anaesthetic.

Will I have any pain or bleeding?

You may have some period-like pain for a few days. Simple pain relief such as paracetamol or ibuprofen should relieve this. Usually, you will bleed for a few days. During this time, it is best to use sanitary towels rather than tampons to reduce the risk of infection. As the womb heals you will continue to have a watery blood-stained discharge for 3 to 4 weeks.

After your operation

• You should rest for 24 hours
• You can have a bath or shower the day after your operation
• You can have sex again as soon as the discharge stops but you should use contraception as you did before the operation
• You can continue with your normal activities 2 to 3 days after your operation