Endometrial resection at Hereford Hospital

What is endometrial resection?

Endometrial resection is a surgical way of treating heavy periods: your gynaecologist cuts away and removes the tissue lining your womb (the endometrium), rather than destroying it with heat or cold. It's usually considered once medicines haven't brought heavy bleeding under control.

What conditions does endometrial resection treat?

Endometrial resection can be offered for:

• heavy periods that haven't responded well to medicines such as tranexamic acid, hormone tablets, or a hormonal coil.

What are the benefits of endometrial resection?

Around 9 in 10 women having resection for heavy bleeding see a real improvement, and for the majority, periods become very light or stop entirely.

It offers a way of avoiding a hysterectomy, or having to take medicine long-term just to manage your periods.

Not every woman benefits, and a small proportion who don't see an improvement eventually choose to have their womb removed (a hysterectomy) instead.

What happens before endometrial resection?

You'll typically have a pre-assessment check first, particularly if sedation rather than a general anaesthetic is planned.

• stop eating around 6 hours beforehand, since sedation carries a small risk of feeling sick, though clear drinks remain fine up to 2 hours before
• carry on taking your regular medicines, swallowed down with just a little water
• If your care team has recommended it, you can take a painkiller such as paracetamol before the procedure, but please mention this to the nurse when you arrive at the hospital
• some women are given a hormone injection around a month ahead, which shrinks any fibroids and makes the womb lining thinner beforehand, though it can bring on brief menopause-like symptoms.

A nurse will note some basic details, such as your height and weight, talk you through the procedure, and check you're happy to give your written permission.

What happens during endometrial resection?

1. Sedation or a general anaesthetic is arranged first, chosen according to what suits you and the plan for your surgery.
2. A narrow telescope-like instrument is guided in via the vagina, through the cervix, and into the womb itself.
3. Fluid is run through this instrument to open the womb out gently, so the lining is easier to see clearly.
4. An electrically heated wire loop then cuts the lining away, along with whatever polyps or small fibroids happen to be in the way.
5. As a rule, this is finished within about half an hour and doesn't require an overnight admission.

What does recovery look like?

Coming round from sedation is usually fast, and it's common to be back on your feet and sent home within a couple of hours; occasionally someone needs longer and is moved onto a ward for a while. Someone responsible needs to bring you home and stay overnight, and if tissue was sent away for testing, results typically follow in 3 to 4 weeks.

Plenty of women manage a full return to normal life and work within a day, but for others it takes up to 1 to 2 weeks, and that's entirely normal too. A few days of light spotting or thin blood loss is to be expected, and it isn't unusual for your next period to arrive heavier or drag on longer than you're used to.

Avoid tampons, menstrual cups, douching, swimming or sexual intercourse for 3 to 4 weeks, or until all watery bleeding has completely stopped. You can use sanitary pads safely. Please speak to your medical team for details about this.

What are the risks and complications?

Endometrial resection is commonly carried out and generally safe, though as with any operation there are risks, including:

• discomfort, or a queasy or sick feeling
• bleeding or a discharge
• infection
• a clot forming in a vein in your leg or lung
• a tear or hole in the wall of your womb (perforation), occasionally with injury to a structure nearby
• fluid overload, where fluid used during surgery passes into your bloodstream and disturbs its normal balance of fluid and salts
• the operation not achieving the result you'd hoped for.

Perforation affects fewer than 1 in 100 procedures and is normally managed just by keeping a close eye on you afterwards. Needing a hysterectomy to control bleeding during or right after the operation happens in under 1 case in 500, and fluid overload bad enough to cause breathing trouble or fits is rarer still, at under 1 in 1,000.

Serious complications of this kind are uncommon but possible with any operation, so it's worth talking through how the risks apply specifically to you before deciding to go ahead.