Endometrial Ablation

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Endometrial ablation is a procedure that surgically destroys (ablates) the lining of your uterus (endometrium). The goal of endometrial ablation is to reduce menstrual flow. In some women, periods may stop completely. No incisions are needed for an endometrial ablation: it is carried out through the vagina and cervix (neck of the womb). Usually, a hysteroscopy is carried out to start with, to check the size and shape of the inside of the womb.  A small, specialised instrument is then used to carry out the ablation. We use either the Novasure device or Librata device. In cases where the ablation cannot be carried out using Novasure or Librata, the womb lining can be removed (resected) using a heated loop. This is called a transcervical resection of endometrium (TCRE).

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When is endometrial ablation indicated?

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Endometrial ablation is a treatment for heavy periods. You may have an endometrial ablation if you have:

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• Unusually heavy periods with clots or flooding which affect your quality of life

• Bleeding that lasts longer than eight days

• Anaemia from excessive blood loss

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When is it not recommended?

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Endometrial ablation generally is not recommended for postmenopausal women or women who have:

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• Not completed their family

• Problems affecting the size or shape of the uterus

• Cancer of the uterus, or an increased risk of uterine cancer

• An active pelvic infection

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Risks

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Complications of endometrial ablation are rare and can include:

• Pain, bleeding or infection

• Heat or cold damage to nearby organs

• A puncture injury of the uterine wall from surgical instruments; this may involve damage to surrounding organs

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Future fertility

 

Pregnancy can occur after endometrial ablation. However, these pregnancies carry higher risk to mother and baby. The pregnancy might end in miscarriage because the lining of the womb has been damaged; the baby may be unable to grow properly later on in pregnancy, and it is possible that the placenta can invade too far into the womb, leading to dangerous blood loss around delivery.

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Some types of sterilisation procedures can be carried out at the time of endometrial ablation. If you are having endometrial ablation, long-lasting contraception or sterilisation is recommended to prevent pregnancy.

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How to prepare

 

Leading up to the procedure, your doctor might:

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• Perform a pregnancy test. Endometrial ablation can not be done if you're pregnant.

• Check for cancer. A fine tube (Pipelle biopsy) is inserted through your cervix to obtain a small sample of the lining of the womb to exclude cancer.

• Remove an IUD. Endometrial ablation is not performed with an IUD in place.

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What you can expect

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During the procedure

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Endometrial ablation procedures vary by the method used to remove your endometrium. Two of the most common options include:

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• Electrosurgery. A small hysteroscope is used to look inside the uterus. An instrument passed through the scope, such as a wire loop, is heated and used to carve furrows into the endometrium. Electrosurgery requires general anesthesia.

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• Heated balloon. A balloon device is inserted through your cervix and then inflated with heated fluid. Depending on the type of balloon device, the procedure can take from 2 to 10 minutes.

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After the procedure

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After an endometrial ablation, you may experience:

• Cramps. You may experience tummy cramps, like period pains, for a day or two after the procedure. These can be treated with painkillers, such as paracetamol or ibuprofen.  Some women have reported experiencing more severe or prolonged pain after having endometrial ablation. In this case, you should speak to your GP or a member of your hospital care team who may be able to prescribe a stronger painkiller.

• Vaginal discharge. A watery discharge, mixed with blood, may occur for a few weeks. The discharge is typically heaviest for the first few days after the procedure.  If it is offensive please contact your GP or a member of our team, to exclude a pelvic infection.

• Frequent urination. You may need to pass urine more often during the first 24 hours after endometrial ablation.

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Results

 

It might take a few months to see the final results, but endometrial ablation usually reduces the amount of blood lost during menstruation. Most women will have lighter periods, and some will stop having periods entirely. Endometrial ablation is not a sterilisation procedure, so you should continue to use contraception.