Endometrial Ablation

What is endometrial ablation?

Endometrial ablation is the treatment for heavy bleeding where the lining of the womb ( endometrium) is ablated or destroyed using various forms of energy like heat and hot water

It is usually offered as an alternative to hysterectomy in selected patients who have not responded to medical treatments.

This treatment may not be recommended if the womb has other abnormalities like fibroids or adenomyosis.

Endometrial ablation is only offered to those women who have completed their family. Once the lining is treated you should not get pregnant as it will have serious consequences. You should therefore continue with contraception.

This operation does not affect the ovarian hormones or the time of onset of the menopause. You will still need to have regular cervical smears.

How effective is this operation?

Endometrial ablation works well for most women. Around 80% of women are satisfied with the results after endometrial ablation.

About half of these women have significantly lighter periods and about half find that their periods stop completely within a year of the operation.

Recent studies have shown that it is less effective in younger women. In patients where endometrial ablation has not been successful the next option is usually a hysterectomy

What are the risks of having an endometrial ablation?

Endometrial ablation is a commonly performed and generally safe procedure. For most women, the benefits are greater than the disadvantages. However, all surgery carries an element of risk.

  • There is a small risk of developing an infection of the womb for which you may need antibiotics.
  • There is a small risk of damage to the womb, vagina, cervix and/or part of the bowel and heavy bleeding from the womb.
  • These complications are rare but if they do happen, you may need further surgery.
  • There is also a small risk of reaction to the anaesthetic but this will be discussed with you by the anaesthetist who will see you before your operation.

The risks of endometrial ablation are far less than the risks of having a hysterectomy.

Preparing for your operation

No specific preparation is required. It is usually done as a day case procedure. In some cases your doctor may give you hormone-based medication for a month or two before the procedure to thin the lining of your womb. The medicine may be given either as an injection.

If you normally take medication (e.g. tablets for blood pressure), continue to take this as usual unless your doctor tells you not to. If you are unsure about taking your medication, please contact your GP.

About the operation

Endometrial ablation is usually done as a day case

Endometrial ablation is usually performed under general anaesthesia. This means you will be asleep during the procedure and won’t feel any pain.

After the anaesthesia has taken effect, a telescope – called a hysteroscope – may be inserted through the vagina and into your cervix, so that your doctor can see the womb. Special instruments are then used to destroy the womb lining. There are a variety of methods.

As we now use special kits to endometrial ablation, occasionally there can be instrument failures. If this happens your doctor may bring you back for a second attempt or carry out the ablation using an electric loop (older technique)

  • Novasure destroys the lining of the womb with electrical energy
  • Thermal balloon ablation – the lining of the womb is destroyed by using a balloon with hot water

After your operation

If you have had general anaesthesia, you will be taken from the operating theatre to the recovery room, where you will come round from the anaesthesia under close supervision. After this, you will be taken back to your room. A nurse will monitor your heart rate and blood pressure at regular intervals. You will be wearing a sanitary towel, as you will have some vaginal bleeding.

You will need to rest until the effects of the anaesthesia have passed. You may feel discomfort similar to period pain as the anaesthesia wears off. Painkillers will be available to help with this. If you continue to feel pain, please discuss this with your nurses or doctors. When you feel ready, you can begin to eat and drink, starting with clear fluids. You will be able to go home once you have made a full recovery from the anaesthesia. However, you will need to arrange for someone to drive you home.

After the operation you are likely to feel some discomfort similar to period pain for a few days. You will also have some vaginal bleeding, similar in amount to a normal period and you may experience other vaginal discharge. This may last for up to a month. You should use sanitary towels rather than tampons.

After you return home

If you need them, continue taking painkillers as advised.

General anaesthesia can temporarily affect your co-ordination and reasoning skills; so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.

You should be able to resume your normal lifestyle after a week. This includes returning to work, driving, sports and sexual activity. (You should resume your normal method of contraception).