Endometrial ablation

Endometrial ablation is a surgical technique used to help women with heavy periods. The theory is that the lining is where the period is derived from. So removal of this lining should stop the periods altogether. It is a very useful technique for reducing and in some cases stopping period loss altogether. However, the latter is not guaranteed and even if the periods initially disappear, they can come back over time.  This is because the lining extends up into the tubes and so cannot be totally removed. In some cases with a condition like adenomyosis, the lining can regenerate. In others, the lining is too thick and the burning is not sufficient to remove it all. It also goes without saying that the closer one has this procedure to the menopause, the more successful the procedure is likely to be. So if it is performed in younger women say in their late 30’s, it is more likely that their periods will recur or get heavier again over time. I therfore always advise my patients that this procedure should be seen as one to reduce the period loss with cessation of periods being a bonus.

Developed initially using a cutting technique, it has now evolved to using burning techniques to remove the lining of the womb. The big advantage is that is performed through the vagina by inserting a telescope or instrument into the cavity of the womb and then removing the lining. Quick to perform, it can significantly reduce the period loss.  In some many cases it can stop the periods completely. It can be performed as a day case, meaning that the woman is discharged the same day. The recovery too is quick, measured in days, not weeks. Without doubt it is a significant advance for treating women with heavy period loss.

Unfortunately nothing comes free in this world.  Free of risk that is. Some of the risks of the procedure relates to:

  1. Perforation of the womb during the procedure. This means that the device in accidentally inserted into the cavity of the tummy through a hole made in the wall of the womb during the procedure. It can lead to burning and damage to the internal organs like the bowel an bladder. Should this happen then one may need a big cut in the tummy to deal with this problem.
  2. Bleeding – sometimes one may experience heavy bleeding which can be uncontrolled resulting in the need for a hysterectomy on the spot.
  3. This can happen with any procedure and I normally would cover the operation with antibiotics.
  4. Scarring in the womb. This is normal and is part of the healing process. However, in some instances, if the scarring is low enough, it may block the opening of the neck of the womb. If you are still having bleeding, then the blood may not come out and this can lead to a lot of pain as the womb tries to “squeeze “ the blood out. This may not happen for a while and when it does happen, it may not be recognised. Eventually the penny drops and if the blockage cannot be overcome, then you may need a hysterectomy.

    In other cases, if you have abnormal bleeding in the future say, post menopause, it may be difficult to check on this as the scarring may preclude a D and C. We may not be able to get into the womb and you may need to consider a hysterectomy then to try to resolve this problem.

  5. Failure of the procedure. It just didn’t work! Yes folks, that can happen. But in at least 90% of women they will have significantly improved periods.

It is important to understand that the risks of complication are low. Nonetheless, the risks and benefits of the procedure needs to be assessed for the individual person.

There are 2 methods for removal of the lining:

  • Resection of the lining. This involves actual cutting of the lining under vision by inserting a telescope into the cavity of the womb. It allows visualisation of the surgery and the tissue removed is sent for pathology testing. It will take slightly longer to undertake than the ablation technique but has the advantage that if there is a fibroid or polyp in the womb, then they will be seen and removed at the same time. Also it works better if the shape of the womb is irregular as can happen with some.
  • Ablation of the lining. This is currently the most common technique use as it is simpler and gives a good result. It again involves putting in an instrument into the cavity of the womb. However, it is inserted in a “blind” fashion. Then a variety of techniques are used to heat the lining of the womb ranging from passing hot water through a balloon in the cavity through to using microwave to heat and burn the lining. Each procedure has a different method to try to ensure that the device is place correctly inside the womb. However, it is not until after the procedure when a telescope is put in to check the cavity that one knows if a perforation has occurred. It may not be possible to use this technique where the shape of the womb or in the presence of large fibroids that distort the cavity too much. As the issue is burnt, it cannot be kept for pathology testing.

. Either technique is suitable to use with both giving good results.  The risks are low and the outcome is good. Having used both, my personal preference is the resection method

These notes reflect my personal opinion and are intended for general advice only. It should not be used for any one individual case. You should consult your own doctor to determine the appropriate management of your own individual situation.