What is endometrial ablation?

Endometrial ablation is a surgical procedure that burns the lining of the uterus (which is called the ‘endometrium’). The endometrium is what thickens and sheds every month, when a woman has a period. Burning it attempts to halt this monthly thickening and shedding of the uterine lining.

Reasons to consider endometrial ablation

Heavy menstrual bleeding

The main reason for considering an endometrial ablation is if your periods are too heavy. Please see this blog post regarding heavy periods, to work out whether or not your periods are too heavy: essentially, if you think that your periods are too heavy, they are!

In most cases, medications are trialled initially, to try to lighten your periods. If they don’t work well enough, an endometrial ablation may be a good next option for you.

Completed your family

While it is still possible to fall pregnant after having an endometrial ablation, doing so can be extremely dangerous for the developing fetus (as it can cause significant fetal abnormalities). There is also an increased risk of miscarriage and ectopic pregnancy (when the embryo grows in the Fallopian tube, rather than the uterus), both of which can be dangerous for you.

Therefore, endometrial ablation should only ever be considered if you have completed your family: you should not have an endometrial ablation if there is a chance that you may want to have more children. Hence, it’s important that you have reliable contraception going forwards, which may include:

• A Mirena IUD, which can be inserted at the same time as your endometrial ablation
• Having your Fallopian tubes ‘tied’ (or removed) using keyhole surgery, which can be performed at the same time as your endometrial ablation, through holes in your tummy
• Or vasectomy of your male partner, if relevant

Painful periods / pelvic pain

It’s important to note that endometrial ablation is NOT a treatment for painful periods or pelvic pain: it is to treat heavy (not painful) periods.

How is endometrial ablation performed?

Endometrial ablation is performed in an operating theatre under general anaesthetic, so you won’t feel or remember anything. Your gynaecologist will start by performing a ‘hysteroscopy’, which means using a very narrow video camera to go through the vagina and cervix, and look at the inside lining of the uterus. If a biopsy (or sample) of the uterine lining hasn’t recently been taken, your doctor will do so: this is called a ‘dilatation and curettage’.

There are several methods which can be used to perform an endometrial ablation, including:

• ‘Novasure’: a small metallic fan is opened inside your uterus, so that it presses against the uterine lining. An electric current is run through the fan, which burns the uterine lining.
• ‘Thermablate’ or ‘Cavaterm’: a sterile balloon is inserted into the uterine cavity, then distended with how sterile liquid. The balloon conforms to the shape of the uterine cavity, and the heat from the liquid burns the uterine lining.
• Endometrial resection: under video guidance, a stiff wire loop with an electrical current running through it is used to shave off strips of the uterine lining, rather like scooping ice-cream
• Rollerball: under video guidance, a rollerball with an electrical current running through it is used to burn the uterine lining

Broadly speaking, the above methods are equally likely to be effective.

Your gynaecologist will decide upon an endometrial ablation method for you based upon:

• Their expertise with each option
• Which option is available at that particular hospital
• Whether or not you have any fibroids distorting the uterine cavity
• Medical considerations, such as your risk of bleeding

How likely is it that endometrial ablation will work for me?

The aim of endometrial ablation is to lighten your period. How likely it is to achieve this depends on several factors, such as:

• Underlying cause of your heavy bleeding: endometrial ablation is less likely to be effective if you are thought (on ultrasound) to have [ ‘adenomyosis’ ]. This is because ablation doesn’t treat the underlying problem.
• Your age: the younger you are, the more years of periods you have until you go through menopause. So endometrial ablation is less likely to be effective: you may want to proceed straight to a hysterectomy.

Generally speaking, the average outcomes after an endometrial ablation are:

• No periods at all (called ‘amenorrhoea’), which occurs in 40% of women
• Very light periods / spotting (40% of women)
• Lighter periods (10% of women)
• Ongoing heavy periods (10% of women)

What are the possible complications of an endometrial ablation?

Generally, having a hysteroscopy and endometrial ablation performed is extraordinarily safe. Possible complications include:

• Uterine perforation, when one of our surgical instruments accidentally goes through the uterine wall (approximately 1 in 200 chance). If this happens, we realise it, and may suggest that you stay in hospital overnight for antibiotics through a drip. Very rarely (less than 1 in 500 cases) we may be worried about internal organ damage, so would proceed (while you’re still asleep) to keyhole surgery through your belly button, to make sure no serious injuries have occurred
• Heavier bleeding for a few hours post-procedure, which may be managed using medications, a ‘catheter’ (small balloon inserted into the uterus to apply pressure for a few hours), or (very rarely) a blood transfusion

Topic area frequently asked questions (FAQs)

Does it matter where I am in my cycle, when my endometrial ablation is performed?

The Novasure or resection techniques can be performed at any time in your menstrual cycle. The Thermablate, Cavaterm, or rollerball techniques work best if performed just after your period has finished, when the uterine lining is at its thinnest.

Will I have any bleeding after I have an endometrial ablation?

It’s normal to have vaginal bleeding for up to a week after your endometrial ablation. There may be a red-brown discharge for up to 6 weeks following an ablation.

It can take up to 6 months for any positive impact on your heavy periods to take effect.

What if endometrial ablation doesn’t work?

As noted above, approximately 10% of women continue to have ongoing heavy periods after an endometrial ablation. Options at this point include medications or hysterectomy.

Hysterectomy is the only definitive ‘cure’ for heavy periods, in that it is the only option that is guaranteed to lead to no monthly periods at all.

Can I have an endometrial ablation if I’ve had a Caesarean section previously?

Yes, you can, if your Caesarean was a standard operation, with a horizontal scar on the uterus. If you had a so-called ‘classical Caesarean’ (where the uterine scar is vertical, which is only very rarely performed), it’s fine to have an endometrial ablation using the resection or rollerball methods, but not Novasure, Thermablate, or Cavaterm.

When can I have insertive sex, after having an endometrial ablation?

You can have sex as soon as the bleeding and discharge have stopped, or after 4 weeks. Studies have shown that sexual function actually improves after an endometrial ablation, presumably because heavy bleeding is less of an impediment.

Will having an endometrial ablation put me into early menopause?

No: endometrial ablation does not affect the ovaries, nor cause any hormonal changes. You will go through menopause whenever you were going to, endometrial ablation aside.

Conclusion

Endometrial ablation can be a good option to manage your heavy periods, especially if you are in your mid- to late-forties, have completed your family, and ultrasound has not shown adenomyosis. 80% of women who have an endometrial ablation avoid having a hysterectomy, so a simple day procedure now could negate the need for a bigger operation later on!