Endometrial ablation

Endometrial ablation (womb ablation) is a surgical treatment to treat 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 get lighter.

About endometrial ablation

A specialist doctor (gynaecologist) may recommend you have endometrial ablation if you have very heavy periods that affect your daily life. The procedure involves thinning and destroying the lining of your womb without removing your womb. Although your womb is left in place, endometrial ablation isn’t a suitable treatment if you plan to have children in the future.

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

Preparation for endometrial ablation

Your doctor will talk to you about what you’ll need to do before your operation.

• If you smoke, it’s a good idea to make every effort to stop before your procedure. This is because smoking can cause breathing problems during and after your operation, and slow your recovery.
• Endometrial ablation is usually done as a day-case procedure. This means you can have the procedure and 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. Your hospital will give you some instructions on when to stop eating and drinking. This is usually from around six hours before your procedure – but always follow your doctor or anaesthetist’s advice. Local anaesthesia blocks pain and discomfort in your cervix and you’ll be awake during surgery.
• Your hospital might ask you to wear compression stockings, which will help prevent blood clots forming in the veins in your legs (deep vein thrombosis).

Your doctor 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 about it. No question is too small. It’s important that you feel fully informed so you’re in a position to give your consent for the operation to go ahead. You’ll be asked to sign a consent form.

Your doctor may need to check some things before your procedure. For example, you may need to have an ultrasound to check your womb and ovaries. And your doctor may need to take a sample of cells (biopsy) from the lining of your womb.

Endometrial ablation procedure

Endometrial ablation usually takes around half an hour.

There are several different types of endometrial ablation. Your doctor will pass a thin camera called a hysteroscope through your vagina and cervix to see inside your womb. They’ll put fluid in your womb so they can see clearly.

Your doctor will use instruments to destroy or remove the lining of your womb. There are different ways to do this – the main ways are listed below.

• Radiofrequency. Your doctor will put a probe through your cervix and into your womb, which will send electromagnetic energy into the lining of your womb. The energy destroys the lining.
• Heated balloon. Your doctor will put a balloon into your womb and pass heated fluid into it, which expands the balloon until it touches the lining of your womb. The heat from the balloon destroys your womb lining.
• Electrosurgery. Your doctor will put a device called a resectoscope through your cervix and into your womb. The resectoscope has an electrical wire loop or roller-ball that destroys the lining.

Aftercare for endometrial ablation

If you had local anaesthesia, you may be able to go home soon after your operation. It’s a good idea to ask a family member or a friend to drive you home.

If you had general anaesthesia, 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 after the endometrial ablation. Ask someone to drive you home and to stay with you 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 doctor’s advice.

Your doctor will discuss any follow-up care with you.

Recovering from endometrial ablation

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

• You’ll probably have some vaginal bleeding for a few days after your procedure, like a light period. Sometimes this can last up to a month. You can use sanitary towels until the bleeding stops – it’s best not to use tampons. If your discharge becomes smelly or changes colour or you have pain and feel unwell, you may have an infection. If this happens, contact the unit where you had your endometrial ablation surgery, or a GP.
• Wait until any vaginal discharge or bleeding has stopped before you have sex. And most importantly, wait until you feel ready. It’s unlikely that you can get pregnant after endometrial ablation but it’s still possible. So you’ll need to use contraception after the procedure until you’ve been through the menopause .
• You may have some stomach cramps. Your hospital may give you some pain-relief medicine before you leave. Or 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 may feel tired for the first few days. Ask family or a friend for some help and support with day-to-day activities, such as food shopping or looking after children (if you have them).
• It’s important to get moving and exercise as soon as you feel up to it. Go for at least a couple of gentle walks for around 15 to 20 minutes on the first day, then you can build up to more strenuous exercise after a couple of days.
• 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 work. You may need to return to work gradually over a week or so.

Side-effects of endometrial ablation

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

• 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 around six to eight weeks

Complications of endometrial ablation

Possible complications of endometrial ablation include:

• an infection
• damage to your cervix, vagina, womb, bladder or bowel – you may need more surgery to repair the damage
• fluid overload. During the procedure, your doctor will use fluid to fill your womb so they can see it clearly. This can potentially get into your bloodstream and if it happens, they’ll need to stop your procedure as it can be harmful to your lungs.

If you notice any pain or feel like something isn’t quite right, see your doctor or seek urgent medical advice.

Considerations for endometrial ablation

It’s important to take your time to decide whether endometrial ablation is the right treatment for you. There are different types of womb ablation – one of these may be more suitable for you than the others. Talk to your doctor about the different options and if endometrial ablation is a good choice for you.

Here are some things to consider.

• The operation can ease heavy periods.
• You’re less likely to have complications with endometrial ablation than with a hysterectomy (surgery to remove your whole womb).
• You’re most likely to 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.
• It may not be the best treatment if you have pain as well as heavy periods – hysterectomy may be a better option.
• There’s a chance that your heavy periods may come back and endometrial ablation fails to help you. If this happens, you might need more surgery, such as another endometrial ablation or hysterectomy.

Endometrial ablation isn’t always a suitable treatment – for more information, see our FAQ: Can anyone have endometrial ablation? And although it’s unlikely you’ll get pregnant after having endometrial ablation, it isn’t impossible. If you do get pregnant, you’re more at risk of miscarriage and other complications. So, if you want to have children or more children in the future, endometrial ablation isn’t the right treatment for you.

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 before you have endometrial ablation.

• Intrauterine system (IUS) is a plastic T-shaped device that’s put in your womb and releases a hormone. It works by thinning the lining of your womb and reducing bleeding. It may also be an option to have an IUS fitted after endometrial ablation to give you further help with heavy bleeding.
• Medicines such as the combined oral contraceptive pill or tranexamic acid 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.