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Endometrial ablation

Endometrial ablation (womb ablation) is a surgical treatment for women who have heavy periods (menorrhagia). During the procedure, most of your womb (uterus) lining will be destroyed or removed. This may stop your periods completely, or they may become lighter.

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About endometrial ablation

Endometrial ablation may be recommended if you have very heavy periods that affect your daily life.

If your periods are very heavy, you’ll lose a lot of blood each month. This can affect your physical and emotional health. It may make you feel anxious or worried, which may mean you avoid going out, running daily errands or socialising. It can also make you more prone to iron deficiency anaemia, which means you don’t have enough red blood cells to take oxygen around your body. Iron deficiency anaemia can make you feel tired and breathless.

The endometrial ablation procedure involves breaking down the lining of your womb without removing your uterus. Although your uterus isn’t removed, endometrial ablation isn’t suitable if you still plan to have children (or more children).

Deciding on endometrial ablation

Endometrial ablation has several pros and cons and isn’t suitable for all women. So it’s important to take your time to decide whether it’s the right treatment choice for you. There are several different types of womb ablation – one of these may be more suitable for you than the others. Talk to your doctor, do your research and consider your personal circumstances before making a decision.

The pros of endometrial ablation include the following.

  • The operation can ease heavy periods – often better than using medicines.
  • It’s done as a day-case procedure, which means you can go home on the same day.
  • You’re less likely to have complications with endometrial ablation than with a hysterectomy (surgery to remove your whole womb).
  • You’re less likely to need painkillers after ablation than after a hysterectomy.

The cons of endometrial ablation include the following.

  • The operation can cause some side-effects and complications, such as an infection or damage to your womb.
  • Sometimes endometrial ablation doesn’t reduce heavy periods at all. It may also not be the best treatment if you have pain as well as heavy periods.
  • Sometimes the heavy periods come back and women need more surgery.

Endometrial ablation isn’t suitable as a treatment option if:

  • you want to have children (or more children)
  • you have large fibroids
  • you have, or may have, cancer of the womb (uterus)

It’s unlikely that you’ll get pregnant after having endometrial ablation, but it isn’t impossible. If you do become pregnant, you’re at an increased risk of miscarriage and other complications. So if you want to have children in the future, or more children, endometrial ablation isn’t the right treatment for you.

Preparing for endometrial ablation

You’ll meet the surgeon carrying out your endometrial ablation to discuss your care. It may be different from what’s described here because it’ll be designed to meet your individual needs.

Your surgeon will talk to you about what you’ll need to do before your operation. If you smoke, you’ll be asked to stop.

You can have the procedure any time, but your surgeon may decide to do the ablation just after your period ends. This is when your womb lining is at its thinnest.

You may be given medicines, such as misoprostol, just before the procedure to soften or dilate the neck of your womb (cervix). This makes it easier to insert the surgical instruments into your womb during the procedure.

Endometrial ablation is usually done as a day-case procedure. This means you can go home on the same day. You’ll have the operation under local or general anaesthesia, depending on which type of ablation you have. If you have general anaesthesia, you’ll be asleep during the procedure. A general anaesthetic can make you sick so it’s important that you don’t eat or drink anything for six hours before your procedure. You can usually drink water up to two hours before, but check with your anaesthetist or surgeon and always follow their advice. Local anaesthesia completely blocks feeling in your cervix and you’ll stay awake during surgery. If you have a local anaesthetic, you may be able to go home a couple of hours after the procedure.

You may be asked to wear compression stockings on your legs. This will help prevent blood clots forming in the veins in your legs (deep vein thrombosis). You may also need to have an injection of an anti-clotting medicine as well as, or instead of, wearing compression stockings.

Your surgeon will discuss with you what will happen before, during and after your surgery. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed so you’re happy to give your consent for the operation to go ahead. You may be asked to do this by signing a consent form.

Alternatives to endometrial ablation

If endometrial ablation isn’t right for you, there may be some other options available to you. Your doctor may suggest you try some of these options before you have endometrial ablation.

Your doctor may offer you an intrauterine system (IUS). This is a plastic T-shaped device, placed in your womb. It releases a hormone similar to progesterone. It works by thinning the lining of your womb and reducing bleeding. See our information on intrauterine system (IUS) for heavy periods.

Your doctor may prescribe you some medicines such as the combined oral contraceptive pill or tranexamic acid.

These medicines may reduce the amount of blood you lose during each period.  

If all other treatment options aren’t suitable, you may be offered a hysterectomy to remove your womb. But this should be a final option because hysterectomy is more likely to cause complications than if you have endometrial ablation. See our information on hysterectomy.

Endometrial ablation procedure

Endometrial ablation is a quick operation. It usually takes no more than 45 minutes, including the time needed for anaesthesia and waking up afterwards.

There are several 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. It sends radiofrequency energy into the lining of your womb. The energy and heat destroy the lining.
  • Freezing. A thin probe is inserted into your womb. This 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.

Aftercare for endometrial ablation

If you had a local anaesthetic, you may be able to go home soon after your operation. Many women prefer not to drive themselves home, just in case they feel uncomfortable or unwell. If you had a general anaesthetic, you’ll need to rest until the effects of the anaesthetic have worn off. You’ll stay in hospital for about three to four hours following your endometrial ablation. You should find someone to drive you home afterwards and have an adult with you at all times for the first 24 hours.

After a general anaesthetic, you may find you’re not so coordinated or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important. Always follow your surgeon’s advice.

You’ll need to wear a sanitary towel as you’ll have some vaginal bleeding afterwards. This is usually like a light period.

You’ll be asked to come back for a follow-up appointment around six weeks after you’ve had the procedure. You may also have an appointment after four months to see how you’re getting on.

Recovering from endometrial ablation

It may take you a few days to recover from endometrial ablation. But every woman is different and it’s important to go at your own pace.

You may have a dull ache, similar to period cramps/pain, for a couple of days after your operation. You may be given some pain relief medicine when you leave the hospital. If you need pain relief at home, you can takeover-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 may also feel tired for the first few days. 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 your job, you should be able to go back to work two to five days after your endometrial ablation. But this will depend on how physically demanding your job is, and how many hours you usually work. You may wish to return to work gradually over a week or so.

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 the unit where you had your surgery or your GP – you may have an infection. Use sanitary towels rather than tampons for three or four weeks after your operation to help lower your risk of getting an infection. Wait until any vaginal discharge or bleeding has stopped before you have sex. And most importantly, wait until you feel ready. If you have any pain or bleeding during or after sex, contact your surgical unit.

You’ll most likely have lighter periods after endometrial ablation. You may even stop having periods altogether. But there’s a chance that you won’t notice any change at all. If endometrial ablation doesn’t control your bleeding, you may need further treatment. See your GP or surgeon if you start to have heavy periods again.

Getting pregnant after endometrial ablation is unlikely but still possible. So you’ll still need to use contraception after the procedure until you’ve been through the menopause. Alternatively, you may want to consider sterilisation or having an intrauterine system (a type of contraception) inserted at the same time as endometrial ablation. Sterilisation is a permanent method of contraception. Ask your doctor for more information.

Side-effects of endometrial ablation

Endometrial ablation may cause some side-effects. These include:

  • feeling sick or being sick after your operation – this is normal and is caused by the anaesthetic
  • tiredness for a few days
  • cramping pains or discomfort, similar to period pains, but this won’t last too long – a few hours to a few days
  • some vaginal bleeding and discharge, which may last for up to three to four weeks – if your discharge becomes smelly or changes colour, contact the unit where you had your surgery or your GP, as this may be a sign of an infection

Complications of endometrial ablation

Endometrial ablation can cause a few complications, like any medical procedure. Any operation can cause an unexpected reaction to the anaesthetic, excessive bleeding or 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:

  • infections
  • damage to your cervix or vagina
  • damage to your womb, bladder or bowel – you may need more surgery to repair the damage
  • burns to your womb, vagina or skin when heated liquids and probes are used
  • scarring inside your womb

If you notice any pain or feel like something isn’t quite right, see your doctor or seek medical advice without delay.

Endometrial ablation doesn’t work well for everyone. You may need to have an alternative treatment, such as a hysterectomy. See Alternatives above for more information.

FAQ: Can anyone have endometrial ablation?

Endometrial ablation isn’t suitable for every woman. Your doctor will talk to you about whether it’s right for you. They’ll ask you about your medical history and lifestyle before they recommend endometrial ablation as a suitable option for your heavy periods.

Endometrial ablation isn’t recommended if:

  • you want to have children, or more children
  • you’re under 35
  • you have large fibroids – for more information, see our FAQ on fibroids below
  • you have an infection in your pelvis
  • you’ve recently been pregnant
  • you have, or may have, cancer of the womb

If endometrial ablation isn’t right for you, there are other treatment options available.

Your doctor may also suggest a different type of treatment if:

  • you’ve had a type of surgery called myomectomy to treat fibroids
  • you’ve previously had a pelvic infection
  • your uterus (womb) is an unusual shape or size
  • you have fluid in your fallopian tube – known as hydrosalpinx
  • you’ve had a caesarean delivery – you may still be able to have endometrial ablation, but your doctor will check the thickness of your scar using ultrasound before going ahead with the procedure 

For more information about treatment options, speak to your doctor.  

FAQ: Can heavy periods come back after endometrial ablation?

It’s possible that your heavy periods may return after having endometrial ablation.

Ablation works by destroying the lining of your womb. Sometimes after the operation, some women find that their periods don’t stop completely, though they may be lighter. Some women find that their periods are light at first and then get heavier again over time.

If your heavy periods return, you may be able to have endometrial ablation again using a different technique. If it isn’t possible to have endometrial ablation again, your surgeon may suggest a different treatment, such as a hysterectomy.

FAQ: Can I have endometrial ablation if I have fibroids?

It depends on how big and where your fibroids are. You can have endometrial ablation if your fibroids are small – less than 3cm, and in a position where endometrial ablation would be technically possible. Endometrial ablation can be done when the fibroids are in the cavity of your uterus.

Fibroids are benign (non-cancerous) tumours that grow in or on the muscle that lines your womb (uterus). Most fibroids are small and don’t cause any symptoms. But sometimes fibroids grow larger and cause heavy periods and/or pain in your pelvis.

If your fibroids are larger than 3cm, there are other treatment options available. These include uterine artery embolisation (UAE) and hysterectomy (removal of your womb). UAE is a procedure that cuts off the blood supply of the fibroids. This causes the fibroids to shrink.

Details

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  • Other helpful websites Other helpful websites

    Sources

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    Reviewed by Laura Blanks, Specialist Health Editor, Bupa Health Content Team, February 2018
    Expert reviewer Miss Shirin Irani, Consultant Gynaecologist
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