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Published by Bupa's health information team, July 2008.
This factsheet is for women who are planning to have an endometrial ablation, or who would like information about it.
Endometrial ablation is a surgical treatment for heavy periods (menorrhagia) where most of the womb lining is destroyed or removed using energy such as microwaves or heat.
Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.
About endometrial ablation
Endometrial ablation is an effective treatment for heavy periods. Heavy periods can affect many aspects of your life and increase your risk of having anaemia (a condition where you don't have enough red blood cells to transport the oxygen around your body), which in turn can make you feel tired, breathless and faint.
What are the alternatives?
Endometrial ablation may be recommended only if non-surgical treatments, such as taking medicines (such as the combined oral contraceptive pill) or an intra-uterine system (a coil in the womb - Mirena®) don't help reduce heavy bleeding.
Endometrial ablation is not usually recommended if you have growths in your womb (fibroids) or if you want to have children in the future, because it affects fertility.
Preparing for your procedure
Your surgeon will explain how to prepare for your procedure. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.
Your surgeon may prescribe some medicine a month before the procedure to thin your womb lining. This makes the treatment more effective. The medicine may be given either as an injection or as a course of tablets.
Endometrial ablation is usually done as a day case under local anaesthesia. This completely blocks feeling in the neck of the womb (cervix) and you stay awake during the procedure. A sedative may be given with a local anaesthetic to help you relax. Sometimes general anaesthesia is used. This means you will be asleep during the procedure.
Your surgeon will advise which type of anaesthesia is most suitable for you.
If you have local anaesthesia, you may be given medicine to help stop the womb from cramping. This is a normal response to treatment.
If you have general anaesthesia, you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.
At the hospital your nurse may check your heart rate and blood pressure, and test your urine.
Your surgeon will explain the procedure and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.
Your nurse will prepare you for theatre. You may also be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.
About the procedure
Endometrial ablation usually takes about half an hour.
A telescope called a hysteroscope is passed through the vagina and cervix so that your surgeon can see your womb. Special instruments are then used to remove the womb lining using one of several methods.
Electrocautery (or diathermy) - a low-voltage electric current is passed through a wire loop or ball-shaped sensor to burn the womb lining.
Laser ablation - a high-energy beam of light burns the womb lining.
Heated fluid - a balloon-like device is placed in the womb and filled with fluid. The fluid is heated to destroy the womb lining.
Microwave endometrial ablation (MEA) - heat from microwaves is used to destroy the womb lining.
What to expect afterwards
If you have general anaesthesia, you will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.
You will need to wear a sanitary towel as you will have some vaginal bleeding.
You will usually be able to go home when you feel ready. Your nurse may give you a date for a follow-up appointment.
You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.
Recovering from endometrial ablation
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your surgeon's advice.
Follow your surgeon's advice about getting back to your usual activities and having sexual intercourse.
You shouldn't use tampons for at least one month after having an endometrial ablation to help lower your risk of infection.
If you develop any of the following symptoms contact your GP as you may have developed an infection:
prolonged heavy bleeding
vaginal discharge that is dark or smells unpleasant
pain that lasts for more than 48 hours
It can take up to three to six months to see whether the operation has been successful. Most women have lighter periods after the procedure, others will stop having periods altogether. Contact your GP or surgeon if you start to have heavy periods again.
What are the risks?
Endometrial ablation is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
These are the unwanted but mostly temporary effects of a successful treatment, for example, feeling sick as a result of the general anaesthetic.
You are likely to feel some discomfort similar to period pain for a few days. You will also have some vaginal bleeding, similar in amount to a normal period. This may last for up to a month.
This is when problems occur during or after the operation. Most women are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
Complications specific to endometrial ablation are rare but can include:
- infection of the womb - antibiotics can help treat an infection
- damage to the womb, vagina or cervix, and/or part of the bowel - this may require further surgery to repair the damage
It is possible that your heavy periods may return and endometrial ablation may need to be repeated.
The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.
- Microwave endometrial ablation. National Institute for Health and Clinical Excellence (NICE), 2003. www.nice.org.uk, accessed 21 April 2008
- Endometrial ablation. American Society for Reproductive Medicine. www.asrm.org, accessed 21 April 2008
- Fluid-filled thermal balloon and microwave endometrial ablation techniques for heavy menstrual bleeding. National Institute for Health and Clinical Excellence (NICE), 2004. www.nice.org.uk, accessed 21 April 2008
- Justin W, Ibraheim M, Bagtharia S, Haloob R. Review: Current minimal access techniques in the treatment of heavy menstrual bleeding. The Obstetrician and Gynaecologist 2007; 9:223-232
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Mr Robin Crawford, MD, FRCS, FRCOG, Consultant Gynaecologist, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: July 2008.