Endometrial ablation – Summary

​

1. Ablation is a treatment to reduce or stop periods.
2. Many women also see a reduction in period pain.
3. An ablation is a good choice for many women with heavy periods.
4. Usually performed as day case surgery in Hospital.
5. Endometrial ablation is well tolerated by most women.
6. Generally, a few days to a week needed to fully recover.
7. Complications are not common.
8. Your family must be complete, and contraception or a partner’s vasectomy is still needed.

Any surgical or invasive procedure carries risks.

 

Endometrial ablation – What is it?

​

Endometrial ablation is a well-tolerated procedure to reduce heavy periods. The ablation operation the lining of the womb by the use of heat or energy. Heavy or irregular periods will stop in only 40% of patients. For the rest of the patients 80% report a reduction to lighter flow. Period pain is often reduced. Some women may experience just spotting rather than a period after their endometrial ablation. Around 20% of patients may not be satisfied after this operation and may require additional treatment.

 

Who should have endometrial ablation?

​

Not all women with heavy periods are suitable. Some abnormal uterine conditions like some fibroids, or some shapes of womb, may make ablation more difficult. If you still want to have children, endometrial ablation is not an option since the uterine lining is removed during the treatment. If you have had a female sterilisation, or your partner has had a vasectomy, an ablation can be an ideal choice for heavy periods. Endometrial ablation has been growing in popularity, as women realise they can stop annoying heavy periods with fast recovery.

 

There are different types of endometrial ablation

 

1. Novasure endometrial ablation

​

Novasure is radio-frequency energy controlled endometrial ablation. A fan-like device is inserted carefully into the womb after measuring it. The device checks to make sure the placement is fine, and the device is then activated. The RF energy removes the lining of the womb. It can get “into the corners” of the uterus better than the balloon types of ablation – as long as the womb is a normal size and shape. Overall, you’re more likely to completely get rid of your periods with Novasure compared with other type of ablations. Over 40% of women will have no further periods, and most of the rest will have very minimal bleeding. Period pain is also often reduced. Novasure is good for regular-shaped wombs. Most of our endometrial ablations  are done using Novasure.

 

2. Other types of endometrial ablation

The other types of ablation are performed using an operating hysteroscope. The lining is treated, or carved out (resected) and/or cauterised while fluid irrigates the womb and keeps the view clear. This is how endometrial ablation used to be done before the technology of Novasure was perfected. These old methods take longer, requires a lot more skill, are more expensive, and there are slightly more potential complications. The methods can still be good if you have something in the womb like a fibroid or a septum that prevents one of the newer methods from being used. For instance, we can resect a problem fibroid, and then treat the rest of the womb at the same time.

 

Can I get pregnant after endometrial ablation?

​

Endometrial ablation should never be used if you ever want to have children. Pregnancies after ablation are rare, and can be very dangerous for both baby and mother. Since there is a chance of pregnancy, excellent contraception or, even better, male or female sterilisation should be in place after treatment. 

 

What will I feel after the endometrial ablation?

​

You will usually feel mild or moderate cramping like a period. We will give you simple painkillers to make you feel more comfortable. After a few hours in Hospital, you should be driven home where you can take it easy for the rest of the day. Occasionally there is no pain, or sometimes more severe pain which needs stronger painkillers.

 

What can I expect after I go home?

​

Most women can return to light work and family commitments a few days to a week after endometrial ablation. Sexual activity can be resumed after your first check-up after 2 weeks. Most patients have a pinkish and watery discharge for up to a month or so. In rare cases, the first period after the ablation is heavy, but this will begin to improve thereafter.

You should seek medical help if you develop a fever, pelvic pain not relieved by ibuprofen, vomiting, or a greenish discharge.

 

What are the risks with endometrial ablation?

​

The endometrial ablation is generally a safe procedure. The commonest risk is getting an infection afterwards which affects about 1/20 women. This is usually managed with a course of antibiotics. There are some very rare, but possible, risks including blood loss, burn of internal organs or cervix or vagina, and perforation or rupture of the wall of the uterus. We’ve never seen any of these complications so far in our practice. Collection of blood or tissue in the womb during the months afterwards is also possible and may require another procedure to correct the problem. All of these risks are very rare.