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Endometrial ablationThis factsheet is for women who are having or thinking of having an endometrial ablation. Your care may differ from what is described here because it is adapted to meet your individual needs, so it's important to follow your doctor's advice.
What is endometrial ablation?Endometrial ablation is treatment to destroy (ablate) part of the womb lining (endometrium). It is used to treat women who have heavy periods, known as menorrhagia. Heavy blood loss each month can lead to a reduced number of red blood cells in the bloodstream (anaemia), making you feel tired and unwell. For more information, please see the separate Bupa health factsheets, Menorrhagia and Anaemia. If medicines don't reduce your menstrual bleeding, then your GP or gynaecologist (a doctor specialising in women's reproductive health) may suggest endometrial ablation as an alternative to major surgical options, such as hysterectomy. This treatment is not usually recommended if the bleeding is due to growths in your womb (fibroids). It's also not suitable for women who may want to have children in the future, because it affects fertility. More than a third of women who have this operation stop having periods. Others find that their periods become lighter. It can take up to three months to see whether the operation has been successful. Some women need to have the procedure repeated. Endometrial ablation is usually performed under general anaesthesia. This means you will be asleep during the procedure and won't feel any pain. Certain endometrial ablation techniques can be performed under local anaesthesia. This involves one or two injections into the neck of the womb. The local anaesthesia numbs the area so that the procedure is painless, but you will stay awake. For more details on anaesthesia, please see the separate Bupa health factsheets, General anaesthesia, and Local anaesthesia and sedation. Endometrial ablation is usually done as a day case but an overnight stay in hospital is sometimes required. Your doctor will explain the benefits and risks of having endometrial ablation, and will discuss the alternatives to the procedure. What are the alternatives?Alternative treatments include:
Your doctor will give you more information about these treatments and discuss whether they are suitable for you. Preparing for your operationThe hospital will send you a pre-admission questionnaire. Your answers help hospital staff to plan your care by taking into account your medical history and any previous experience of hospital treatment. You will be asked to fill in this questionnaire and return it within three days. Your doctor may give you hormone-based medication for a month or two before the procedure to shrink the lining of your womb. This makes the treatment more effective. The medicine may be given either as an injection or as a course of tablets. Side-effects of the medication can include vaginal dryness, hot flushes and night sweats. If you normally take medication (eg tablets for blood pressure), continue to take this as usual, unless your doctor tells you not to. If you are unsure about taking your medication, please contact the hospital. Before you come into hospital, you will be asked to follow some instructions.
When you arrive at the hospital, a nurse will explain how you will be cared for during your treatment. Your doctor may also visit you. This is a good time to ask any questions. The nurse will help you prepare for theatre and will do some simple tests such as measuring your heart rate and blood pressure, and testing your urine. You may be asked to wear compression stockings to help prevent blood clots forming in the veins of your legs (deep vein thrombosis - DVT). For more information, please see the separate Bupa health factsheets, Deep vein thrombosis and Compression stockings. If you are having local anaesthesia, you may be given a medicine to help prevent the womb from cramping, which is a normal response to treatment. You may also be offered a sedative to help you relax. About the operationAfter the anaesthesia has taken effect, a telescope - called a hysteroscope - is inserted through the vagina and into your cervix, so that your doctor can see the womb. For more information, please see the separate Bupa health factsheet, Hysteroscopy. Special instruments are then used to remove the womb lining. There are a variety of methods.
Endometrial ablation usually takes about half an hour. After your operationIf you have had general anaesthesia, you will be taken from the operating theatre to the recovery room, where you will come round from the anaesthesia under close supervision. After this, you will be taken back to your room. Back on the wardA nurse will monitor your heart rate and blood pressure at regular intervals. You will be wearing a sanitary towel, as you will have some vaginal bleeding. You will need to rest until the effects of the anaesthesia have passed. You may feel discomfort similar to period pain as the anaesthesia wears off. Painkillers will be available to help with this. If you continue to feel pain, please discuss this with your nurses or doctors. When you feel ready, you can begin to eat and drink, starting with clear fluids. Going homeIf your operation has been planned as a day case, you will be able to go home once you have made a full recovery from the anaesthesia. However, you will need to arrange for someone to drive you home. You should try to arrange for someone to stay with you for the first 24 hours. Before you leave, your nurse will give you a contact telephone number for the hospital and a follow-up appointment with your doctor, usually two to six weeks after your operation. After you return homeIf you need them, continue taking painkillers as advised. General anaesthesia can temporarily affect your co-ordination and reasoning skills; so you should not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. Follow your doctor's advice about going back to your normal lifestyle, including driving, sports, sexual activity and contraception. Most women go back to work within a few days. Deciding on having an endometrial ablationEndometrial ablation is a commonly performed and generally safe procedure. For most women, the benefits are greater than the disadvantages. However, all surgery carries an element of risk. In order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications. Side-effectsSide-effects are the unwanted but mostly temporary effects of a successful treatment. An example of a side-effect is feeling sick as a result of the anaesthetic or painkillers. You are likely to feel some discomfort similar to period pain for a few days after the operation. You will also have some vaginal bleeding after the operation, similar in amount to a normal period. This may last for up to a month. You should use sanitary towels rather than tampons. Please contact the hospital if the bleeding becomes heavy. Complications are when problems occur during or after the operation. Most women are not affected. The possible complications of any surgery include excessive bleeding during or very soon after the operation, infection and an unexpected reaction to the anaesthetic. It is also possible to develop a blood clot in a vein in one of the legs (DVT). In addition, complications specific to endometrial ablation include infection of the womb after the operation and damage to the womb, vagina, cervix and/or part of the bowel. These complications are rare but if they do happen, you may need further surgery. Ask your doctor to explain how these risks apply to you. The exact risks will differ for every person. This is one of the reasons we have not included statistics in this factsheet. Further information
Sources
Published by Bupa's health information team, healthinfo@bupa.com, March 2005.
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