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Endometrial ablation

What is an endometrial ablation?

Endometrial ablation is a medical procedure that is used to remove, or destroy, the lining of the uterus (endometrium).

Why ablation?

The lining of the uterus (endometrium) is shed by bleeding each month during a woman's menstrual period. Sometimes the bleeding is too much or too long and treatment is needed. If bleeding does not respond to medication, your doctor may suggest endometrial ablation. 

This procedure treats the lining of the uterus to control or stop bleeding without having to remove the uterus.

What are the alternatives?

Endometrial ablation is one of several options to manage heavy bleeding. Alternatives would include anti-inflammatory tablets, the oral contraceptive pill, other progesterone preparations, Mirena intra-uterine system, and hysterectomy.

Will I still have periods after an ablation?

About one third of women will stop having their periods after an ablation, but most women will have lighter periods. Over time, periods usually return so ablation is often not the best option for women who are many years away from menopause (more than ten years).

Can I become pregnant after an ablation?

Most women are not able to become pregnant after an ablation; therefore, you should not have an endometrial ablation if you may want to become pregnant in the future. 

Although pregnancy is unlikely after an ablation, you should take measures to avoid a pregnancy until after menopause. Falling pregnant following an ablation is often complicated with significant risk to the developing baby and may be dangerous for you. 

Ablation does not affect sexual response. 

How is an ablation performed?

Ablation destroys a thin layer of the lining of the uterus. If ablation does not control heavy bleeding, further treatment or surgery may be required.

The procedure is normally performed under local or general anaesthetic in the operating theatre. Your doctor will determine your suitability to have the ablation under local anaesthetic according to your previous obstetric and gynaecological history and the examination findings.

The cervix is widened (dilated) and a telescope is inserted to look at the inside of your uterus. There are several methods that your doctor may choose to burn away the uterine lining. These include electrical or thermal (heat) ablation. This procedure does not involve any cuts or stitches to the abdomen. 

How long does the ablation take?

The procedure only takes approximately ten minutes, but you can expect to be in theatre and recovery for a number of hours.

What are the risks of undergoing this procedure?

Although the risks associated with ablation are minimal, you should be aware that every surgical procedure has some risk.

There are some specific risks to be aware of in relation to this operation:

  • The procedure may not be able to be completed, due to narrowing of the interior of the cervix. Further surgery may then be necessary.
  • If you have had a previous caesarean birth, an ultrasound may be requested to measure the thickness of the uterine scar, to help decide if it will be safe for you to have an ablation. 
  • It is possible to make a small hole in the uterus (uterine perforation). In most circumstances this is of no consequence. However, this may require a laparoscopy and/or laparotomy, resulting in a longer hospital stay than expected. In the event of uterine perforation, the ablation may not go ahead. There is a risk of damage to adjacent organs, such as bowel or bladder, which may require further corrective surgery.
  • In a very few cases, the fluid used to expand your uterus may be absorbed into your bloodstream. This may allow too much fluid in your body and can be serious, causing your hospital stay to be prolonged.
  • Infection could be introduced into the uterus, tubes or abdominal cavity. This would require treatment with antibiotics.
  • Excessive bleeding from the uterus can occur. This may require blood transfusion and further surgery.

There are some general risks inherent to all operations:

  • Small areas of the lungs may collapse, increasing the risk of chest infection. This may require treatment with antibiotics and physiotherapy.
  • Clots in the legs with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be fatal.
  • You may suffer a heart attack or stroke because of strain on the heart. Death is an extremely rare possibility for anyone undergoing an operation.

Some women are at an increased risk of complications, including:

  • women who are very overweight—these women have an increased risk of wound infection, chest infection, heart and lung complications and blood clots
  • women who smoke—smokers have an increased risk of wound and chest infections, heart and lung complications and blood clots.

What should I expect after the procedure?

You can expect to and experience some lower abdominal discomfort and/or pain. You may use paracetamol (Panadol) as ordered, and if stronger medication is needed please contact your doctor. Please ensure you follow your doctor's instructions when using any pain medication.

It is also normal to expect some bleeding or blood-stained vaginal discharge.

Discharge advice

It is common to have ongoing light bleeding and/or watery loss for several weeks. While you are still bleeding or have vaginal loss, it is important for you to:

  • shower (not bath), 
  • use pads (not tampons)
  • avoid swimming 
  • avoid sexual intercourse 

Routine cervical screening tests are still needed as all your reproductive organs are still in place.

Contact

Please contact either your General Practitioner (GP); Mater Hospital Brisbane Day Procedure Unit on 07 3163 8324; or Mater Hospital Brisbane Emergency Department on 07 3163 8111 IMMEDIATELY if you experience any of the following after discharge:

  • A fever (temperature 38 degrees Celsius or higher) or are feeling unwell.
  • Offensive vaginal discharge or heavy bleeding.
  • Nausea and vomiting which does not settle.
  • Unable to empty your bladder or bowel.
  • Severe pain.

References

Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Endometrial ablation patient information. 2017.

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430159
Last modified 10/7/2020.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 30/6/2020
For further translated health information, you can visit healthtranslations.vic.gov.au/ supported by the Victorian Department of Health and Human Services that offers a range of patient information in multiple languages.
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