Like many procedures, there are pros and cons of endometrial ablation. It’s important to take your time to decide whether endometrial ablation is the right treatment choice for you. Talk to your doctor, do your research and consider your personal circumstances before making a decision.
The pros of endometrial ablation include the following.
- It can be effective at easing heavy periods – more so than treatment with medicines.
- It’s done as a day-case procedure, which means you can go home the same day.
- The risk of complications is less with endometrial ablation compared to a hysterectomy.
However, endometrial ablation isn’t suitable as a treatment option if:
- you want to have children
- you have large fibroids
- you have endometriosis
Your surgeon will talk to you about how to prepare for your endometrial ablation. If you smoke, you will be asked to stop, because smoking increases your risk of getting a chest infection, which can slow your recovery.
Your surgeon may prescribe you medicines, such as nafarelin (Synarel) or goserelin (Zoladex), for you to take for up to six weeks before your operation. Nafarelin comes in the form of a nasal spray. Zoladex is given as a one-off injection. These medicines help to thin the lining of your womb, which makes the treatment more effective and reduces your chance of complications. These medicines can cause side-effects – your doctor will talk to you about these. Alternatively, your doctor might plan to do the procedure just after your period has ended, when the lining of your uterus is at its thinnest.
Endometrial ablation is usually done as a day-case procedure, which means you can go home the same day. Depending on the type of ablation you have, you may have the operation done under either local or general anaesthesia. Local anaesthesia completely blocks feeling in the neck of your womb (cervix) and you stay awake during the procedure. General anaesthesia means you will be asleep during the operation.
An anaesthetic can make you sick so it’s important that you don’t eat or drink anything for six hours before your operation. Follow your doctor’s advice. If you have any questions, just ask.
You may also be given medicines just before the procedure, such as misoprostol, to soften or dilate your cervix. This makes it easier to insert the instruments into your womb during the operation.
If you’re unsure about anything, ask. Understanding what’s going to happen can help you feel more at ease and comfortable. You will be asked to give your consent by signing a form. You may also be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.
There are other options available if endometrial ablation isn’t right for you. For example, you might be offered an intrauterine system (IUS). This is a plastic T-shaped device, placed in your womb, which releases a hormone similar to progesterone. It works by thinning the lining of your womb and reducing the bleeding. See our information on intrauterine system (IUS) for heavy periods for more detail.
Other options include medicines such as the combined oral contraceptive pill or tranexamic acid.
These options may be recommended before endometrial ablation.
If all other treatment options have failed, you may be offered a hysterectomy to remove your womb. But this should be a final option because there is more risk of complications compared with endometrial ablation. See our information on abdominal hysterectomy for more detail. Becoming pregnant after having endometrial ablation is unlikely, but still possible. However, you’re at an increased risk of miscarriage and other complications if you do become pregnant. If you would like to have children in the future, or more children, endometrial ablation isn’t the right treatment for you.
Although becoming pregnant is unlikely, you will need to use contraception after the procedure until you have been through the menopause. Alternatively, you may want to consider sterilization. This is a permanent method of contraception and can be done at the same time as endometrial ablation. Ask your doctor for more information.
Endometrial ablation is a quick procedure, usually taking no more than 45 minutes, including the time needed for anaesthesia and waking up afterwards.
There are a number of different types of endometrial ablation. For some of the techniques, your surgeon will pass a thin camera called a hysteroscope in through your vagina and cervix. This is so they can see inside your womb.
Your surgeon will then use special instruments to destroy or remove the lining of your womb using one of several methods. The main ones are listed below.
- Radiofrequency. A probe is inserted into your womb through your cervix, which sends radiofrequency energy into the lining of your womb. The energy and heat destroy the lining. There is also a gentle suction to remove it.
- Freezing. A thin probe is inserted into your womb, which then freezes the lining of your womb. Your doctor will use an ultrasound scan to help guide them through the procedure.
- Heated fluid. Fluid is inserted into your womb through a hysteroscope. The fluid is heated and stays in your womb for about 10 minutes. The heat destroys the lining of your womb.
- Heated balloon. A balloon is placed into your womb using a hysteroscope. Heated fluid is then put into the balloon, which grows until it touches the lining of your womb. The heat from the balloon destroys your womb lining.
- Electrosurgery. A device called a resectoscope is inserted into your womb through your cervix. The resectoscope has an electrical wire loop, roller-ball, or spiked-ball tip that destroys the lining. This technique is usually done under general anaesthesia, which means you’ll be asleep during the procedure.
If you have general anaesthesia, you will need to rest until the effects of the anaesthetic have passed. You will stay in hospital for about three to four hours following your endometrial ablation.
You might find that you’re not so coordinated or find it difficult to think clearly. This is normal after general anaesthesia and should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important.
You will need to wear a sanitary towel as you will have some vaginal bleeding afterwards. This is usually like a light period.
You’ll be asked to come back for a follow-up appointment, which can be any time between two and six weeks after you’ve had the procedure.
You may have a dull ache, similar to period cramps/pain, for a couple of days after your endometrial ablation. You may be given some pain relief medicine when you leave the hospital. If you need pain relief at home, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your nurse or pharmacist for advice.
You might also find that you need to urinate more frequently for a day or so afterwards. You may feel tired for a few days after your operation. Ask for some help and support with day-to-day activities, such as food shopping or looking after your children if you have them. Depending on what you do as a job, you should be able to go back to work two to five days following endometrial ablation.
You may have some vaginal bleeding for a few days and a watery discharge for up to three to four weeks. If your discharge becomes smelly or changes colour, or if you have pain and feel unwell, contact your GP because you may have an infection. Use sanitary towels rather than tampons for three or four weeks after having endometrial ablation to help lower your risk of infection.
For many women who have the procedure, a common question is when they can have sex again. Similar to the advice about tampons, wait three or four weeks until you have sex to reduce your risk of infection. Also wait for any vaginal discharge or bleeding to stop. And most importantly, wait until you feel ready. If you have any pain or bleeding during or after sex, contact your GP.
You will most likely have lighter periods after endometrial ablation. You may even stop having periods altogether. However, there is a chance that some women won’t see any change. If the procedure doesn’t help control your bleeding, you may need further treatment. See your GP or surgeon if you start to have heavy periods again.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. You may feel sick or be sick after your operation. This is very normal and is caused by the anaesthetic. You may have some cramping pains or discomfort, similar to period pains, but this won’t last too long – a few hours to a few days. You will also have some vaginal bleeding and discharge, which may last for up to three to four weeks. If your discharge becomes smelly or changes colour, see your GP or your surgeon, as this might be a sign of infection.
Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot. Blood clots usually occur in a vein in the leg (deep vein thrombosis, DVT).
Complications specific to endometrial ablation are rare but can include:
- damage to your cervix or vagina
- damage to your womb, bladder or bowel – you may need further surgery to repair the damage
- burns to your womb, vagina or skin when heated liquids and probes are used
If you’re having pain or feel like something isn’t quite right, see your doctor or seek medical advice without delay.
Endometrial ablation doesn’t work successfully for everyone and you may need to have the operation again or choose an alternative treatment.
If you’ve previously had a caesarean section, you may still be able to have endometrial ablation. However, to be sure, your doctor will check the thickness of your uterus wall before going ahead with the procedure. They will do this by scanning your womb or using a thin camera called a hysteroscope, which is passed through your vagina to see inside your womb.
Endometrial ablation isn’t suitable for everyone, for example, if you want to have children. Your doctor will talk to you about whether this procedure is right for you. If it isn’t, there are other treatment options available to ease your heavy periods.
Your doctor will ask you many questions about your medical history and lifestyle before they recommend endometrial ablation as a suitable option.
Endometrial ablation isn’t recommended if:
- you want to have children
- you have been through the menopause (post-menopausal)
- you have a small womb
- you have large fibroids
- you have endometriosis
- you have had a previous infection in your pelvis
- you have recently been pregnant
- you have cancer of the womb
Success of endometrial ablation Can heavy periods come back after endometrial ablation? If so, what are my treatment options?
Yes, it’s possible that your heavy periods may come back after having endometrial ablation. The treatment isn’t always successful. However, you may be able to have the treatment again, using a different technique. Alternatively, your surgeon might suggest a different treatment – for example, a hysterectomy.
Endometrial ablation works by destroying the lining of your womb. This means your womb lining can’t thicken during your menstrual cycle and so you have light periods. Sometimes your periods may stop altogether. However, this treatment doesn’t work for everyone. You may find that after your operation, your periods stay the same or are lighter to begin with, but get heavier and longer over time.
There are several different methods used to remove your womb lining, such as heated water, an electric current or radio waves. So, your surgeon may suggest having endometrial ablation again using a different method or repeating the procedure as before.
Having a hysterectomy is the only definite cure for heavy periods, but it has a higher risk of complications than endometrial ablation.
Maybe. It depends how big your fibroids are. You can have endometrial ablation if your fibroids are small – less than 3cm. It will also depend on where your fibroids are located in your womb.
Fibroids are benign (non-cancerous) tumours that grow in or on the muscle that lines your womb (uterus). Endometrial ablation is only recommended if your fibroids are less than 3cm in size. It’s not recommended if you have large fibroids. It will also depend on where your fibroids are located in your womb.
If your fibroids are larger than 3cm, there are other treatment options available, such as uterine artery embolisation (UAE) and hysterectomy (removal of your womb). UAE is when the blood supply of the fibroids is cut off. This causes the fibroids to shrink.
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- Women's Health Concern
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