Endometrial ablation

Endometrial (womb) ablation treats heavy periods (menorrhagia) when other options aren’t possible or haven’t worked. The lining of your womb (uterus) will be destroyed or removed. This surgical treatment is also known as uterine ablation and aims to make your periods lighter. But it may stop them altogether.

About endometrial ablation

Endometrial ablation is an option for women with heavy bleeding if other treatments aren’t possible or haven’t worked. Heavy periods are common – particularly among women aged 30 to 49. Your GP may refer you to a specialist doctor (gynaecologist) for treatment. Hormone contraceptives should normally be tried first, but sometimes these don’t work.

An endometrial ablation destroys the lining of 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.

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 stop smoking before your procedure. This is because smoking can slow your healing after the ablation. Smoking can also make you more likely to get a chest infection afterwards.
• 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 usually have the operation under local anaesthesia, but sometimes general anaesthesia is used. This depends on the type of ablation you have.

Local anaesthesia blocks pain, but you’ll be awake. If you have general anaesthesia, you’ll be asleep during the procedure. Always follow your doctor or anaesthetist’s advice on eating and drinking before general anaesthesia.

If you’re having general anaesthesia, Your hospital will usually ask you not to eat anything for six hours before the operation. You can usually drink water until two hours before. Your hospital might also ask you to wear compression stockings. These help to prevent blood clots in your leg veins (deep vein thrombosis).

Your doctor will discuss with you what will happen before, during and after the type of surgery you have. 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 able to give your consent for the operation to go ahead. You’ll be asked to sign a consent form.

Your doctor may need to complete certain checks 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

There are several different types of endometrial ablation. It will usually take up to half an hour, but some ablation methods are quicker. Your doctor will use instruments to destroy or remove the lining of your womb. There are different ways to do this. All the systems use energy, usually creating heat. There are no surgical cuts. Instead, your doctor will pass the instruments through your vagina to your womb.

The following are the two most common types of uterine ablation procedure.

• Radiofrequency. Your doctor will put a probe through your cervix and into your womb. The type of energy and heat it delivers will destroy the lining.
• Heated balloon. Your doctor will pass a balloon into your womb and inflate it with heated fluid. The heat destroys your womb lining.

Doctors use special devices for ablation, so the method for your surgery may have a brand name. For example, NovaSure endometrial ablation is a radiofrequency method. Thermachoice and Cavaterm are heated balloon options.

Aftercare for endometrial ablation

If you had local anaesthesia, you may be able to go home soon after your operation. 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 this form of 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, use machinery or sign anything important. Always follow your doctor’s advice.

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

Recovery from endometrial ablation

It may take a few days for your endometrial ablation recovery. But everyone’s different in their healing and how they recover, so it’s important to follow 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, you may have an infection. You may have tender pain and feel unwell with this. Don’t ignore these symptoms – contact the unit where you had your endometrial ablation surgery or your GP.
• Intimacy after endometrial ablation. Wait until any vaginal discharge or bleeding has stopped before you have sex. Also wait until you feel ready. You’re much less likely to get pregnant after endometrial ablation, but it’s still possible. So you’ll need to use contraception until you’ve been through the menopause.
• You may have some tummy cramps. Your hospital may give you some medicine for this period-like pain 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. If you have any questions, ask your nurse or pharmacist for advice.
• You may feel tired for the first few days. You may need to ask for some support with day-to-day activities.
• It’s a good idea to get moving as soon as you feel up to it.
• You could be back to work two to five days after your endometrial ablation This depends on your job – if your work is more demanding, you may need to return more gradually.

Side-effects of endometrial ablation

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

• tiredness for a few days
• cramping pains or discomfort like period pains, but this won’t last long – a few hours to a few days
• some vaginal bleeding and discharge for a few days, but sometimes for three to four weeks

Are there any endometrial ablation side-effects years later?

The possible side-effects tiredness and cramp or discomfort shouldn’t last for long. The vaginal bleeding can last for a few days to a few weeks after your endometrial ablation. But these typical endometrial ablation side-effects don’t last for years.

One thing that can happen for some people is that heavy bleeding can come back after they’ve had an ablation. This isn’t a long-term side-effect: this is because the treatment hasn’t worked. So for some people, it’s possible to have symptoms years after ablation. They may need a repeat ablation or other treatments.

Some people can have complications (‘adverse events’) with ablation (see our section: Complications of endometrial ablation)..

For more information, see our section: Considerations for endometrial ablation..

Complications of endometrial ablation

The chances of you having a complication after endometrial ablation are low. Any complications are usually easily managed.

The most common complications of endometrial ablation include bleeding, damage to your womb, and infection. These happen to no more than 1 in every 300 people who have an endometrial ablation.

Rarer complications are also possible. If you’re worried about 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 if 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 does usually ease heavy periods. For every 100 endometrial ablations, 60 to 80 women have lighter periods afterwards. The success rates can be even higher, and often the periods stop altogether.
• But there’s also some chance that your heavy periods come back. This is when endometrial ablation has failed to help you.
• You’re less likely to have complications with ablation than with a hysterectomy. Hysterectomy is surgery to remove your whole womb. For most people, endometrial ablation is the surgical option to try first.
• If womb ablation doesn’t work for you, you might need more surgery. This could be another endometrial ablation or a hysterectomy.

Endometrial ablation and pregnancy

If you want to have children in the future, endometrial ablation isn’t the right treatment for you. It’s not likely you’ll be able to get pregnant after an endometrial ablation. If you do get pregnant, you’re more at risk of miscarriage and other complications.

Alternatives to endometrial ablation

If endometrial ablation isn’t right for you, there may be some other options.

• The levonorgestrel intrauterine device (LG-IUD) is a plastic T-shaped device. It’s put in your womb and releases a hormone. It’s also known as the intrauterine system (IUS). It works by thinning the lining of your womb and reducing bleeding. There may also be an option to have this device fitted after endometrial ablation to further help with heavy bleeding.
• Medicines may reduce the amount of blood you lose during each period. Examples are the combined oral contraceptive pill and tranexamic acid.

There is also a surgical alternative. Hysterectomy is an operation to remove your womb. This may be used when other medical treatments aren’t suitable or haven’t worked.