Endometrial ablation

The endometrium (lining of the uterus) is shed monthly during menstruation. Abnormalities in the endometrium can give rise to excessively heavy or prolonged menstrual bleeding. 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 high success rate.

Endometrial ablation may be a suitable alternative to hysterectomy for some women to address heavy menstrual 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, endometrial-thinning medication may be prescribed for a few weeks. The medication reduces bleeding and thins the endometrium 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 TV monitor. The surgeon then fills the uterus with fluid or air 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 (cryoablation), heated fluid (hydrothermal ablation), or heated balloon (thermal balloon ablation).

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 to assess healing and the effectiveness of the treatment.

Expected outcome of treatment

The goal of endometrial ablation is to reduce the heavy menstrual bleeding to normal or below normal levels. Irrespective of the technique used, endometrial ablation reduces menstrual bleeding in the majority of women and satisfaction rates are high.

Although hysterectomy offers permanent relief from heavy menstrual bleeding, it requires a longer surgery time and recovery period and has higher rates of post-surgery complications than endometrial ablation.

A hysterectomy is often recommended if endometrial ablation is not successful, which occurs in about 20–30% of women who undergo the procedure. 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 endometrial ablation. 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:

• Drug treatment (including hormone replacement therapy)
• Hysterectomy
• Choosing not to have treatment.

For more information on these alternatives please consult your doctor or specialist.

References

Famuyide A. (2018). Endometrial Ablation. J Minim Invasive Gynecol. 2018;25(2):299–307 Fergusson, R.J. (2019). Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2019;(11):CD000329
O’Toole, M.T. (Ed.) (2017). Endometrial ablation. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MO: Elsevier.
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: 22/11/20]

Last Reviewed: November 2020

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