Endometrial ablation at Highgate Hospital

What is endometrial ablation?

Endometrial ablation destroys the endometrium, the layer inside your womb that normally builds up and sheds during each period, using heat, cold or another energy source. It's used to treat heavy periods that haven't settled with other treatments.

What conditions does endometrial ablation treat?

Endometrial ablation is offered for heavy monthly bleeding (menorrhagia) once medication alone hasn’t settled things down. Doctors generally class a period as heavy if it:

• goes on for longer than a week
• leaves you with symptoms of anaemia, such as tiredness or feeling cold
• soaks through a pad or tampon within an hour, repeatedly, over several hours
• stops you going to work, school or social events.

It's usually only offered once your doctor is confident there's no other cause for the bleeding, such as cancer or thyroid disease.

What are the benefits of endometrial ablation?

For many women, endometrial ablation stops or greatly reduces heavy bleeding without the need for daily medication. Around 80% to 90% of women notice lighter periods afterwards, and roughly 1 in 3 stop having periods altogether.

It's also less invasive than a hysterectomy (removal of the womb), which remains the main permanent alternative if bleeding continues to cause problems.

Full results aren't clear straight away: most women need a few menstrual cycles, sometimes up to 3 months, before they know how much their bleeding pattern has changed.

Are there different types of endometrial ablation?

There are several ways to destroy the womb lining, and your gynaecologist will discuss which suits your circumstances:

• microwave: a small applicator heats and destroys the lining, usually in around 3 to 5 minutes
• radiofrequency (such as NovaSure): a mesh-tipped device expands inside the womb and destroys the lining, usually in around 1 to 2 minutes
• electricity (electrosurgery, sometimes called TCRE): a viewing device with a heated wire, ball tip or laser attachment destroys the lining; this method is less common and may need a general anaesthetic
• heated fluid (hydrothermal): warm water vapour destroys the lining over about 10 minutes
• heated balloon: a fluid-filled balloon presses against and destroys the lining, usually in 2 to 10 minutes
• cold (cryoablation): a cold-tipped device freezes and destroys the lining over about 10 minutes.

What happens before endometrial ablation?

Before the procedure, your gynaecology team will usually carry out the following checks:

• a pregnancy test, and removal of any coil (IUD) you have fitted
• a small sample of your womb lining (biopsy) to rule out cancer
• a review of the medicines you take, especially anything that thins your blood
• an ultrasound or a hysteroscopy (a camera inserted through the cervix) to examine your womb
• for some methods, medicine beforehand to thin your womb lining.

You'll be told whether you can eat and drink beforehand, and you should arrange for someone to take you home afterwards, particularly if you're having sedation or a general anaesthetic.

What happens during endometrial ablation?

1. You lie on an examination couch with your legs supported, in a similar position to a smear test.
2. Depending on the method and your preference, your cervix is numbed with local anaesthetic, or you’re put under with sedation or a full general anaesthetic instead.
3. A small camera (hysteroscope) is often passed through your vagina and cervix first, to check the size and shape of your womb.
4. Your gynaecologist passes a thin device through your cervix into your womb, which delivers heat, cold or another energy type into the tissue to break it down.
5. The treatment itself is brief, usually somewhere between 1 and 10 minutes depending on the method used, though your full appointment will take longer.

What does recovery look like?

With a local anaesthetic, you're often free to leave within a short while, though many women arrange for someone else to do the driving. A general anaesthetic usually means staying on the ward across three to four hours or so before you're clear-headed and comfortable, and it's best to have someone else around for the 24 hours that follow in case you feel drowsy or unsteady.

Cramping like a period is common for a day or two, and bleeding typically shifts from a period-like flow into a thinner, watery discharge, sometimes continuing three to four weeks in total. Pads are an essential choice over this time rather than tampons, since anything inserted raises the chance of infection.

You'll usually be sent home with painkillers for the first 48 hours, and while most people are up and about again within days, your periods themselves might need as much as 3 months before settling into their new, lighter pattern.

What are the risks and complications?

As with any procedure, endometrial ablation carries some risks, including:

• heavy bleeding
• infection
• an allergic reaction
• a hole (perforation) in your womb, or burns or damage to nearby organs such as your bowel.

Recovery can take longer if you smoke, are overweight, or have health problems such as diabetes before your operation, since all of these can increase your risk of infection or slow down healing.

Getting pregnant afterwards is unlikely but still possible, and it carries a higher risk of miscarriage or ectopic pregnancy (where the pregnancy develops outside the womb), so it's important to keep using contraception until menopause.

Endometrial ablation isn't suitable for everyone. It may not be recommended if you're past menopause, have a womb infection, fibroids, or endometrial hyperplasia, have womb cancer, or where neither you nor your partner has had a permanent form of contraception and you'd rather not rely on birth control afterwards.