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.
Prior to the surgery, endometrial-thinning medication (eg: danazol, gonadotrophin-releasing hormone agonists) 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 (ablate) the endometrium. There are many techniques that can be used to achieve ablation, including laser vaporisation, microwave energy (microwave ablation), high energy radio waves (radiofrequency ablation), electrical current (electrocautery), freezing cryoblation) heated fluid (hydrothermal ablation) or heated balloon (thermal balloon ablation).
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
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 to endometrial ablation include:
Fergusson, R.J. (2013). Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2013 Nov 29;(11):CD000329
O’Toole, M.T. (Ed.) (2013). Endometrial ablation. Mosby’s Dictionary of Medicine, Nursing & Health Professions (9th ed.). St Louis, MI: Elsevier Mosby.
Pickett, S.D. (2016). Endometrial ablation (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. https://emedicine.medscape.com/article/1618893-overview [Accessed: 21/11/17]