Endometrial ablation

Published by Bupa's Health Information Team, October 2010.

This factsheet is for women who are having endometrial ablation, or who would like information about it.

Endometrial ablation is a surgical treatment for heavy periods (menorrhagia) where most of the womb (uterus) lining is destroyed using laser, radiofrequency waves, microwaves or heated water.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About endometrial ablation

Endometrial ablation is an effective treatment for heavy periods (menorrhagia).

Some women bleed very heavily during their period. Heavy periods can affect many aspects of your life and increase your risk of developing anaemia, a condition where you don't have enough red blood cells to transport the oxygen around your body. This can make you feel tired, breathless and faint.

If you have heavy periods, one way of reducing the amount of blood you lose each month is to remove some of the lining tissue of your womb.

What are the alternatives?

Other treatments for heavy periods include medicines such as the combined oral contraceptive pill or tranexamic acid.

You can also have an intra-uterine system (IUS) placed in your womb. This is a plastic T-shaped device that releases a hormone similar to progesterone and works for up to five years.

Before endometrial ablation was developed, women who had heavy periods were usually offered a hysterectomy to remove their womb. This is still an option, but it's used less often because you're more at risk of complications during and after a hysterectomy compared with endometrial ablation. Having endometrial ablation means you won't be able to have children in the future, so if you want to have children then talk to your doctor about other treatments.

Preparing for endometrial ablation

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest infection, which can slow your recovery.

Your surgeon may prescribe medicines for you to take for a few weeks before your operation. These help to thin the lining of your womb. This makes the treatment more effective and may reduce the amount of bleeding you have during the operation.

Endometrial ablation is routinely done as a day-case procedure. This means you have the procedure and 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 the womb (cervix) and you stay awake during the procedure. General anaesthesia means you will be asleep during the operation. You may also be given medicines to make it easier to insert the instruments into your womb during the operation.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice. At the hospital your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

What happens during endometrial ablation

Endometrial ablation usually takes about half an hour, including the time needed for anaesthesia and for waking up after the procedure.

There are a number of different types of endometrial ablation. For some of the techniques a thin camera called a hysteroscope is passed through your vagina and cervix so that your surgeon can see inside your womb.

Special instruments are then used to destroy or remove the womb lining using one of several methods. The main ones are listed below.

• Electrocautery (or diathermy). A small electric current is passed through a wire loop or ball-shaped sensor, which heats up.
  
• Laser ablation. This uses a high-energy beam of light.
  
• Heated fluid. A deflated balloon is placed inside your womb and filled with a heated fluid.
  
• Microwave endometrial ablation (MEA). A microwave probe is put into your womb and moved from side to side.
  
• Radio waves. A probe is placed inside your womb which uses radio waves.

What to expect afterwards

If you have general anaesthesia, you will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will need to wear a sanitary towel as you will have some vaginal bleeding.

You will usually be able to go home when you feel ready. Your nurse may give you a date for a follow-up appointment. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Recovering from endometrial ablation

If you need pain relief, 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 pharmacist for advice.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you're in any doubt about driving, please contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

You should be able to get back to your usual day-to-day activities about a week after your operation. Follow your surgeon's advice about how long to wait before having sex.

You may have some vaginal bleeding for a few days and a watery discharge for a few weeks. If the discharge becomes smelly or changes in colour, or if you have pain and feel unwell, contact your doctor for advice because you may have an infection.

You should use sanitary towels rather than tampons after having an endometrial ablation, to help lower your risk of infection. Your surgeon will tell you how long you need to wait before using tampons.

It can take a few months to see whether the operation has been successful. Most women have lighter periods after the procedure, some will stop having periods altogether. Contact your GP or surgeon if you start to have heavy periods again.

What are the risks?

Endometrial ablation is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

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. You may have some cramping pains or discomfort, similar to period pains. You will also have some vaginal bleeding and discharge, which may last for a few weeks.

Complications

Complications are when problems occur during or after the operation. Most women aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications specific to endometrial ablation are rare but can include:

• inflammation of the lining of your womb
  
• infection of your urinary tract (bladder)
  
• damage to your womb or bowel - you may need further surgery to repair the damage
  
• burns to your womb, vagina or skin when heated liquids are used.

Endometrial ablation doesn't work successfully for everyone and you may need to have the operation again. The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.