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Endometrial ablation

The endometrium (lining of the uterus) is shed monthly during menstruation.  Abnormalities in the endometrium can give rise to abnormal uterine bleeding (menorrhagia). Endometrial ablation – the removal of  the endometrium - can be an effective treatment for the condition.  Recovery is likely to take two weeks or more and, like all surgical procedures has some risk of complications. The procedure has a 90% success rate.

Endometrial ablation  may be a suitable alternative to hysterectomy for some women to address heavy uterine bleeding.  It is not suitable for women who have problems that affect the wall of the uterus, such as fibroids or tumours, and is not generally used to treat endometriosis.   
 

The procedure

Endometrial ablation is usually done as a day stay procedure. It will be performed in an operating theatre using a regional or general anaesthetic. The procedure may be referred to as endometrial resection depending on the technique used.  

Prior to the surgery, medication may be prescribed for a few weeks. The medication reduces bleeding and thins the endometrium in order to make the ablation procedure easier. 
 

During the procedure

The surgeon opens (dilates ) the cervix and inserts a hysteroscope through the cervix into the uterus. A hysteroscope is a long thin tube with a tiny camera on the end that enables the surgeon to view the inside of the uterus on a television monitor. The surgeon then fills the uterus with fluid or air in order to discourage bleeding and to make the lining of the uterus more visible.

A specially designed surgical instrument is inserted into the uterus and is used to remove or destroy the endometrium. There are a number of techniques that can be used to achieve this including laser, electrical current or freezing. 
 

Recovery

There may be some discomfort, similar to period pain, which can be relieved by taking painkillers such as paracetamol.  Vaginal bleeding is expected and may last for 2-3 weeks after the procedure. It is important not to use tampons during this time. It is also important to avoid sexual intercourse and strenuous activity such as sport for at least two weeks. The surgeon will discuss these guidelines prior to leaving hospital.  The surgeon will arrange for a follow up appointment 2-3 weeks after the procedure in order to assess healing and the effectiveness of the treatment. 

Expected outcome of treatment

The goal of endometrial ablation is to reduce the heavy bleeding to normal or below normal levels. After the procedure about 50% of patients will have no periods and 40% will have reduced periods. In about 10% of patients the procedure is not successful. This may mean that the heavy bleeding continues or pain develops.  A hysterectomy is often recommended if endometrial ablation is not successful. In some patients, particularly if they are at risk of complications from hysterectomy, a repeat ablation may be recommended.

It is not possible to carry and give birth to children after the procedure but endometrial ablation is not considered a form of contraception. Conception can still occur but it would not be possible for the embryo to implant in the endometrial lining in the normal manner. Complications such as miscarriage or ectopic pregnancy can occur. This should be discussed with the surgeon prior to the procedure. 
 
 

Complications and risks

Prior to the procedure the surgeon will discuss the risks and benefits of the endometrial ablation procedure. Complications and risks include:
 
  • Infection or bleeding
  • Injury to the bowel or bladder
  • Damage to the wall of the uterus
  • Incomplete removal of the endometrium. 
Contact the surgeon if any of the following is experienced after the procedure:
 
  • Heavy vaginal bleeding
  • High fever
  • Abdominal pain.

Alternatives

Alternatives to endometrial ablation include:
 
For more information on these alternatives please consult your doctor or specialist.  
 

References

Anderson, K. N., Anderson, L. E. & Glanze, W. D. (Eds.) (2006) Mosby’s Medical, Nursing and Allied Health Dictionary. (6th ed.) St. Louis: The C.V. Mosby Company.

Auckland District Health Board (2007) Endometrial Ablation. Fact sheet. Auckland District Health Board, Women’s Health.
Auckland.

Clinical Reference Systems (2006) Hysteroscopy for endometrial ablation. In Health and Wellness Resource Centre. McKesson Health Solutions.

Women's Health Service, Wellington Hospital (2013) endometrial Ablation. Fact Sheet.  Capital and Coast District Health board, Wellington.
 
Last Reviewed – 7 August 2013

 

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