What is Endometrial Ablation Surgery and Why is it Performed?

08 June 2020    by - Dr Pandelis Athanasias

What is endometrial ablation surgery?

Endometrial ablation is a surgical procedure to destroy (ablate) the endometrium, which is the lining of the uterus (womb). This procedure aims to reduce menstrual flow, making it a treatment option for women suffering from very heavy, painful periods. Endometrial ablation has been developed in the past decade as an alternative to hysterectomy.

Why is endometrial ablation surgery performed?

The procedure is carried out in women with extremely heavy periods (menorrhagia), which are affecting their everyday life. Women with heavy periods will lose a significant amount of blood each month, which often affects their physical and mental health.

Feeling anxious or embarrassed are all common in people with heavy periods, many of whom may begin to avoid going out or socialising for fear of leakage. Menorrhagia can also lead to iron-deficiency anaemia, which occurs when there are not enough red blood cells in the body to carry oxygen around it, due to excessive blood loss. This condition typically makes people feel extremely tired or out of breath.

A period is considered heavy when:

  • Bleeding lasts for longer than a full week
  • When the patient soaks through at least one sanitary pad or tampon every 1-2 hours
  • The patient needs to use double sanitary protection
  • The patient wakes up in the night to change their sanitary pad or tampon
  • Large blood clots are passed during menstruation
  • Heavy menstrual flow is interfering with their day-to-day life
  • The patient is experiencing anaemia and feeling extremely tired during their period

How is endometrial ablation surgery carried out?

Endometrial ablation is a quick procedure (around 45 minutes), which involves breaking down or destroying the uterine lining, without having to remove the uterus (as with a hysterectomy).

There are several different ways of carrying out this procedure, including:

  • Radiofrequency – This involves inserting a probe into the uterus via the cervix, which then sends radiofrequency heat and energy to the uterus lining and destroys it.
  • Freezing – Here, a probe is inserted into the uterus to freeze the lining of it. To help guide the doctor through the procedure, an ultrasound scan will also be used.
  • Heated balloon – A hysteroscope is used to place a balloon into the uterus. The balloon is then filled with heated fluid, which will grow until it reaches the uterus lining. The heat from the balloon will destroy the uterus lining.
  • Heated fluid – A hysteroscope Is used to insert fluid into the uterus. This fluid is then heated, destroying the lining of the uterus.
  • Electrosurgery – A resectoscope, which has an electrical wire loop, spiked-ball tip or roller-ball attached to it, is inserted into the uterus via the cervix and is used to destroy the uterus lining.

How should I prepare for endometrial ablation surgery?

During a prior consultation, patients will meet with their surgeon, who will ask them about their past medical history, including any medications they are taking, whether they have any allergies and if they have had any previous surgery. Patients will be advised to stop smoking or taking aspirin or other non-steroidal anti-inflammatory drugs, such as Ibuprofen, for a specified period of time before the operation.

The procedure can take place at any time, but the consultant may recommend doing it after the end of your period when the lining of the uterus will be at its thinnest. Patients may be prescribed some medicine to take prior to the operation, which helps to dilate the cervix and make it easier to insert the surgical instruments needed to carry out the procedure.

Endometrial ablation is typically carried out as an outpatient procedure, meaning patients will not need to stay at the hospital overnight. Local or general anaesthetic will be used, depending on the type of ablation surgery being carried out. If the patient is going under general anaesthetic, they will be asked not to eat or drink anything for at least six hours before the surgery.

What happens after endometrial ablation surgery?

Typically, it only takes several days to recover from endometrial ablation and return to normal activities, though this varies from patient to patient. For a few days after the procedure, it is common to experience a dull ache and some discomfort in the abdomen, similar to normal period cramps. Over-the-counter pain medication can help relieve this pain. As a result of the anaesthetic, patients may also feel nauseous immediately after the procedure, but this will wear off quickly.

Feeling lethargic for several days following the procedure is commonplace, so it is important to rest up and take a few days off from work. Most people will be able to return to work between 2-5 days after the surgery, depending on the type of job they have. If their job is particularly physically demanding, taking a few more days off is recommended.

Vaginal bleeding and watery discharge are common for the first few weeks, but it is important to note that if the discharge becomes smelly or changes colour, consult your GP, as this can indicate an infection. Likewise, if you start to feel unwell or are in pain, you should seek medical attention.

Patients should avoid using tampons for the first few weeks after the procedure, instead opting for sanitary towels. Sex should also be avoided until the bleeding or discharge has stopped.

Can periods return after endometrial ablation?

As the procedure destroys or removes most of the uterus lining, periods generally become a lot lighter in around 70% of women who undergo it, while in approximately 10% of cases, periods stop altogether. Many women who have painful periods or suffer from pre-menstrual syndrome also note a significant improvement in their symptoms after the surgery.

However, in some women, particularly those under age 40, the treatment may not work to reduce heavy periods, or they may come back in the future. If heavy periods return, your GP may recommend undergoing surgery again and may suggest using a different method.

Can you get pregnant after endometrial ablation?

Although not impossible, it is unlikely that a person will be able to get pregnant after endometrial ablation. This means that the procedure is not suitable for those who plan on having children, or those who have already had children but wish to have more.

Moreover, there is an increased risk of miscarriage or other pregnancy complications in people who have had the procedure.

However, as pregnancy is still a possibility, using contraceptives afterwards (until you reach menopause), is necessary.

Is endometrial ablation surgery painful?

As patients will be under local or general anaesthetic, they will not be able to feel pain during surgery. A dull ache in the abdomen is common for a few days afterwards, but this can be remedied by using standard over-the-counter painkillers.

What other treatments are there for people with heavy periods?

Endometrial ablation surgery is not right for everyone, and there are several other treatment options available for people with heavy periods. Your GP or gynaecologist will recommend trying some of these methods before deciding to undergo surgery.

The hormonal IUD (intrauterine device) may be prescribed, which is a t-shaped device that is placed in the womb and releases a hormone similar to progesterone. The IUD makes the uterine lining thinner and decreases menstrual blood flow and cramps.

The combined oral contraceptive pill is often prescribed to help regulate the menstrual cycle and reduce excessive or prolonged bleeding. Tranexamic Acid (Lysteda) may also be prescribed, which can reduce blood loss but need only be taken when bleeding.

There are also other types of surgery to help with menorrhagia, most of which are only suitable for those whose heavy periods are caused by fibroids.

If all other treatment options fail or are unsuitable, a patient may be offered a hysterectomy, which is a surgery to remove the whole womb. This is a major surgery that ends menstrual periods and means patients cannot get pregnant. It should only be considered as a last resort when all other treatment options have been exhausted.

Is endometrial ablation suitable for everyone?

No, endometrial ablation is not suitable for everyone. It is not recommended for the following patients:

  • Those who want to have children or wish to have more children
  • Those under 35
  • Those who have large fibroids
  • Those with an infection in the pelvis
  • Those who are pregnant or who have recently been pregnant
  • Those who have cancer of the womb

Before recommending endometrial ablation as a treatment for heavy periods, your GP will talk with you about all the different options and discuss whether the procedure is right for you.

See A Consultant