05 Feb 2024

Endometrial Ablation Surgery: Know the Purpose and Procedure

What is endometrial ablation surgery?

Endometrial ablation is a medical procedure designed to ablate, or destroy, the lining of the uterus (endometrium). This procedure is often considered for women experiencing abnormally heavy menstrual bleeding, known as menorrhagia, when such bleeding is unresponsive to other treatments. While endometrial ablation can significantly reduce or even stop menstrual flow, it is important to note that it is not a form of sterilization and may not be suitable for all women. The development of endometrial ablation over the past decades offers an alternative to more invasive procedures like hysterectomy.

Why you need to perform endometrial ablation surgery

Endometrial ablation surgery is considered for women experiencing menorrhagia, a condition characterized by excessively heavy menstrual bleeding that can significantly impact daily life. Women with menorrhagia may lose a substantial amount of blood each month, potentially affecting both their physical and mental health. Common feelings of embarrassment or anxiety associated with heavy periods can lead to social withdrawal or fear of public outings due to concerns about leakage.

One serious complication of menorrhagia is iron-deficiency anemia. This condition occurs when the body lacks sufficient red blood cells to transport oxygen effectively, often due to the excessive loss of blood. Symptoms of iron-deficiency anemia can include extreme fatigue and shortness of breath.

A menstrual period might be considered heavy if:

The bleeding lasts more than a week.
There is a need to change sanitary pads or tampons every 1-2 hours, or if double sanitary protection is required.
Nighttime awakenings are necessary to change pads or tampons.
Large blood clots are passed during menstruation.
The heavy menstrual flow disrupts normal daily activities.
Symptoms of anemia, such as fatigue associated with the menstrual cycle, are experienced.

How endometrial ablation surgery is conducted

Endometrial ablation is a medical procedure designed to ablate, or destroy, the lining of the uterus (endometrium), offering an alternative to a hysterectomy where the uterus itself is not removed. This procedure is typically quick and can be performed using various techniques, each with its unique approach:

Radiofrequency: Involves the insertion of a probe into the uterus through the cervix. This probe emits radiofrequency energy, generating heat that destroys the uterine lining.
Freezing (Cryotherapy): A special probe is inserted into the uterus to freeze the lining. An ultrasound may be used concurrently to guide the doctor and ensure accurate application.
Heated Balloon Therapy: A balloon-tipped hysteroscope is placed into the uterus. The balloon is then filled with heated fluid which expands to make contact with the uterine lining, destroying it through heat.
Heated Fluid (Thermal Ablation): A hysteroscope is used to insert a heated fluid directly into the uterus. The heat from this fluid destroys the uterine lining.
Electrosurgery (Electrocautery): This method utilizes a resectoscope with an electrical wire loop, roller-ball, or spiked-ball tip. Inserted through the cervix into the uterus, it uses electrical energy to cauterize and destroy the uterine lining.

Preparing for endometrial ablation surgery:

Before undergoing endometrial ablation, patients will have a consultation with their surgeon. During this session, it's important to provide a comprehensive medical history, including all current medications, any known allergies, and previous surgical procedures. This information helps ensure the safety and effectiveness of the procedure.

Patients may be advised to make certain lifestyle or medication adjustments prior to surgery. This can include stopping smoking, as smoking can affect healing and recovery. Additionally, it may be necessary to temporarily discontinue certain medications like aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, as these can increase bleeding risks.

Timing of the procedure can be crucial. Often, doctors recommend scheduling the surgery soon after menstrual bleeding has ended, as the uterine lining is thinnest at this time. This can make the procedure more effective and easier to perform.

In preparation for the surgery, patients might be prescribed medication to dilate the cervix. This facilitates easier insertion of surgical instruments during the procedure.

Endometrial ablation is usually carried out as an outpatient procedure, which typically does not necessitate staying in the hospital overnight. Depending on the type of ablation and the patient's health, either local or general anesthesia will be administered. If general anesthesia is used, patients will be instructed not to eat or drink anything for at least six hours before the surgery to reduce the risk of complications during anesthesia.

It is essential for patients to follow all pre-operative instructions provided by their healthcare team to ensure the best possible outcome and minimize risks associated with the procedure.

Recovery after endometrial ablation surgery:

Recovery time following endometrial ablation varies among patients, but it typically takes several days to return to normal activities. Post-procedure, it is common for patients to experience a dull ache or discomfort in the abdomen. This pain can usually be managed with over-the-counter pain medication. Additionally, feelings of nausea may occur immediately after the procedure due to the effects of anesthesia.

Fatigue is a common symptom in the days following the surgery. Patients are advised to rest and take time off from work to facilitate recovery. The exact duration of time off needed depends on the nature of the patient's job and individual recovery progress. People with physically demanding jobs may need to extend their rest period.

Vaginal bleeding and watery discharge are typical in the first few weeks post-surgery. Patients should monitor these symptoms; if the discharge changes color, becomes foul-smelling, or if there are signs of infection, such as fever or severe pain, it is important to consult a healthcare provider promptly.

For the initial recovery period, it is recommended to use sanitary towels instead of tampons to reduce the risk of infection. Sexual intercourse should also be avoided until the bleeding or discharge has completely stopped.

It is essential for patients to follow all post-operative instructions provided by their healthcare provider, including attending follow-up appointments to ensure proper healing and to address any concerns that may arise.

Can periods return after endometrial ablation?

Endometrial ablation is a procedure aimed at reducing menstrual bleeding by removing or destroying much of the lining of the uterus. In approximately 70% of women who undergo this procedure, menstrual bleeding becomes significantly lighter. However, it's important to note that in about 10% of cases, periods may stop altogether.

Women who experience premenstrual syndrome (PMS) or have painful periods often report a noticeable improvement in their symptoms following the surgery. This improvement is attributed to the reduction in menstrual flow and uterine cramping.

However, the effectiveness of endometrial ablation can be less predictable in younger women, particularly those under 40. In some cases, heavy periods may not be adequately reduced, or they might recur after some time. This can be due to the regeneration of the endometrial tissue. If menstrual bleeding returns or remains heavy, it is important to consult with a GP or specialist. They may evaluate the need for additional treatment, which could include a repeat ablation or considering alternative methods.

It's crucial for patients to have a thorough discussion with their healthcare provider about the potential outcomes and the likelihood of needing further treatment, especially inthe context of their age and individual health circumstances.

Is it possible to get pregnant after endometrial ablation?

While endometrial ablation significantly reduces the likelihood of pregnancy, it is important to understand that it is not a form of sterilization, and thus, pregnancy is still technically possible, albeit unlikely. Therefore, this procedure is generally not recommended for women who wish to conceive in the future, or for those who may consider having more children.

For women who do become pregnant after undergoing endometrial ablation, there is an increased risk of miscarriage and other pregnancy-related complications. This is due to the changes in the uterine lining that can affect the implantation and development of the pregnancy. Additionally, pregnancies following endometrial ablation can be high-risk for both the mother and the fetus.

Because of the residual risk of pregnancy and the associated complications, it is strongly advised that women continue to use reliable contraception following endometrial ablation. This is crucial for preventing an unintended and potentially high-risk pregnancy.

It is essential for women considering endometrial ablation to have a detailed conversation with their healthcare provider about the implications for future fertility and the importance of ongoing contraceptive use.

How painful is endometrial ablation surgery?

During the endometrial ablation procedure itself, patients typically do not experience pain as they are under the effects of either local or general anesthesia. Local anesthesia numbs the targeted area, while general anesthesia renders the patient unconscious for the duration of the surgery.There can be severe ache in the abdomen for a few days though this can be treated by taking over-the-counter painkillers.

What other treatments are there for women with heavy periods?

For individuals experiencing heavy menstrual bleeding, there are various treatment alternatives besides endometrial ablation surgery. Your GP or gynecologist will likely explore these options with you before considering surgical intervention.

One option is the hormonal IUD (intrauterine device), a T-shaped device inserted into the uterus that releases a hormone akin to progesterone. This hormone thins the uterine lining, leading to reduced menstrual flow and cramps. The combined oral contraceptive pill is another common prescription, used to regulate the menstrual cycle and lessen heavy or prolonged bleeding. Tranexamic Acid (Lysteda) is also an option; it helps reduce menstrual blood loss and is only taken during bleeding episodes.

For cases where heavy periods are attributed to fibroids, specific surgical procedures can be effective. However, if these methods prove ineffective or unsuitable, a more significant option like a hysterectomy may be proposed. Hysterectomy involves removing the entire womb, permanently ending menstrual periods and the ability to become pregnant. It is generally considered a last resort after all other treatments have been tried and found wanting.

Is endometrial ablation a suitable option for everyone?

Endometrial ablation is not a one-size-fits-all solution and is not suitable for every patient. Certain conditions and circumstances make this procedure inappropriate or risky for some individuals.

Those who are below 35 years
Those who want to conceive or wish to have more children
Those who have large fibroids
Those who have an infection in the pelvis
Those who are pregnant or who have recently been pregnant
Those who have cancer in the womb

Your GP at the Gynaecology Clinic will first discuss all available treatment options with you before recommending endometrial ablation for heavy periods. They will then assess whether this specific procedure is the right choice for your situation.