Endometrial Ablation

Endometrial Ablation

What is endometrial ablation?

Endometrial ablation means the removal of the endometrium (or the lining of the uterus). It is one way to treat heavy periods or abnormal menstrual bleeding. For some women it can be an alternative to hysterectomy.

Endometrial ablation is not appropriate for all women with menstrual bleeding disturbances.  For example, it is suitable when there is any suspicion of cancer or where the uterus is enlarged or contains many fibroids. It is not suitable for women who may wish to become pregnant because in most cases, but not all, it results in infertility.

What is involved?

The procedure involves removal of the endometrium using a roller ball or a cutting loop, to which an electric current is applied. A diagnostic hysteroscopy and curettage (D&C) is performed several months prior to endometrial ablation, to assess whether this procedure would be appropriate and to exclude malignancy. A microwave balloon can also be used effectively.

Frequently, medication is prescribed for six weeks prior to treatment, so that the uterine lining is very thin at the time of the procedure. Danazol and Provera are the most commonly used medications. These are usually well tolerated but occasionally a rash, or a croaky voice necessitates stopping them.

The procedure is performed under a general anaesthetic. The cervix (or neck of the womb) is dilated or stretched and the hysteroscope, which is a narrow telescope, is passed through the cervix. This may be connected to a video monitor. The endometrium or uterine lining can then be removed using electrical current (diathermy). During the procedure, the uterus is continually flushed with a fluid to keep the uterine cavity open and to rinse away blood and
debris.

The procedure usually takes 30 to 60 minutes. The patient can usually be discharged from hospital the same day or the following day.

What results might be expected?

About 20% of women who have this procedure have no further periods and about 70% continue to have light periods. For approximately 10% troublesome periods will persist and hysterectomy may be necessary.

What about complications?

While serious complications are rare, no surgery is without risk of complications. The overall risks and complications will be less than those for hysterectomy. Anaesthesia itself is never without risk and the risks are greater for women who smoke or who are significantly overweight.

During the procedure bleeding is occasionally troublesome and on rare occasions a blood transfusion is necessary. Infection may occur but is generally readily treated. It is possible for the wall of the uterus to be punctured by the instruments or by the electrical current. If this happens there may be damage to the bowel which may require open surgery and hysterectomy may also become necessary. Because of the manner of flushing the uterus the body can absorb excess fluid. This may on rare occasions cause severe problems with blood chemistry. Some of these complications will depend on the nature of the particular problem and the exact technique used. However 99% of patients have no problems.

I am happy to discuss any concerns you may have regarding risks and complications of this procedure.

The Advantages:

Symptoms are improved without having to remove the uterus. Compared with hysterectomy, the hospital tray and convalescence are short, a practical and economic advantage to most women.

Recovery:

Hospitalization is usually as a day case or overnight stay. You may feel drowsy from the anaesthetic for a day or two. One or two weeks of vaginal bleeding may be expected, after which some discharge may persist for up to a month. It is normal to have some aches and cramps during the first week or so. Intercourse should be avoided for about two weeks or until bleeding has stopped and strenuous activity should be avoided for one month. Generally 203 days off work is enough.

Afterwards:

The outcome of the surgery may not be clear for twelve months but as indicated above, the  majority of women have no periods or considerably lighter periods after the procedure. The uterine lining shrinks and the endometrium is replaced by a thin layer of scar tissue. The uterus and neck of the womb are still present so regular pap smears should be continued.

The ovaries are untouched, so hormone function can be expected to continue until the normal time for the woman to experience menopausal symptoms. Apart from the loss of periods, this procedure will not affect the time at which hot flushes, mood changes and other menopausal symptoms would be expected to occur, nor should it have any effect on weight or sexual activity.

It should not be assumed that endometrial ablation will prevent pregnancy. Although pregnancy is unlikely following the procedure, some have occurred. It is not known whether such pregnancies could be expected to have a normal outcome. The doctor should be consulted about contraceptive methods if these are necessary, or sterilization with clips to the tubes can be performed at the same time.

Follow up medical checks will be arranged, usually at about 10-12 weeks and thereafter as appropriate. Smears are still necessary as the cervix is retained.