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The purpose of this leaflet is to help women who are scheduled to have an Endometrial Ablation. If you have any further questions, do not hesitate to ask myself or one of the nursing staff.
What is an Endometrial Ablation?
This is a procedure to treat heavy periods in which the lining of the womb (the endometrium) is destroyed. It is often combined with Hysteroscopy, a procedure in which a fine telescope is passed through the neck of the womb (cervix) in order to see the inside of the womb.
There are several different methods of destroying the endometrium. The two methods I use most commonly are called Resection and Balloon Ablation. Resection involves removing the endometrium with a wire loop through which an electrical current is passed. Balloon Ablation uses a balloon filled with hot water which is placed inside the womb for 8 minutes.
Can fibroids can be removed?
Fibroids that protrude into the cavity of the womb can often be removed using Resection, unless they are very large. Small fibroids can be removed without a significant effect on fertility but the removal of larger fibroids can reduce future fertility.
Which women are suitable for this surgery?
These techniques should only be considered by women who have completed their family because of the risk that subsequent pregnancies would suffer complications. They are only suitable for women with a normal sized or mildly enlarged womb. NICE considers endometrial ablation to be preferable to hysterectomy for suitable women. Although most women report a reduction in period pain following an endometrial ablation, I would not normally recommend this operation for women whose main problem is painful rather than heavy periods.
How successful is it?
80% of women are pleased with effect on their periods and about one third of these will not get any periods at all. For most women the effect will be long-lasting. If symptoms recur, it is possible to repeat the operation.
What anaesthetic will I have?
In the vast majority of cases, you will have a general anaesthetic.
What are the risks?
A small hole is made in the womb (perforation) in about 1% of cases but observation in hospital overnight is all that is usually required. Occasionally a telescope (laparoscopy) may need to be inserted through the belly button to check for signs of internal injury.
Serious complications of endometrial ablation are very rare. Pelvic infection can occur and if you develop abdominal pain, fever +/- discharge you should seek prompt medical care to obtain antibiotics. Significant bleeding is uncommon, the exception being when a large fibroid is removed. In extremely rare circumstances, a hysterectomy may be necessary to stop the bleeding. Rarely a large amount of water can be absorbed by the body and lead to the operation needing to be stopped before the entire womb lining is removed.
What can I expect after surgery?
I will see you after the operation and explain my findings to you. You will usually be able to go home on the same day. Minor lower abdominal discomfort should be expected and Paracetamol, Co-codamol or Ibuprofen are usually sufficient for pain relief. It is usual to have some bleeding which will be bright red at first but will change to brown after a few days. The bleeding can continue for several weeks and you should avoid tampons and sexual intercourse during this time. Your next period may be heavier or lighter than usual. Do not drive for 48 hours. You should be able to return to work after a few days.
Author Robert MacDermott September 2007