Endometrial Ablation/ Resection
What is Endometrial Ablation/Resection?
Endometrial ablation or resection are operative techniques used to remove the endometrium (lining of the uterus) from the uterine cavity. It is one way in which heavy menstrual periods or abnormal uterine bleeding can be treated and for some women is a suitable alternative to hysterectomy.
Endometrial ablation or resection is not always appropriate and where the uterus is very enlarged or has many fibroids or if cancer is suspected would be contraindicated. Similarly if women still wish to become pregnant this technique should be avoided because it often causes infertility.
How is Endometerial Ablation/Resection Performed?
The procedure involves using an operating hysteroscope (telescope) introduced into the uterus to visualise the uterine cavity and through which other instruments are passed to facilitate removal of the endometrial lining.
The endometrium is removed using electrocautery with a roller ball or cutting loop, or sometimes using a laser. Often a diagnostic hysteroscopy and/or dilatation and curettage (D & C) is used beforehand to assess whether ablation is appropriate.
Frequently medication is prescribed for several weeks (3 - 6 weeks) before the date of surgery to ensure that the lining of the uterus is very thin at the time of operation. Your surgeon will discuss this with you and prescribe appropriate medication.
The procedure generally takes 30 - 60 minutes and throughout the operation the uterus is flushed with fluid to maintain distension of the cavity and flush away blood and debris. On occasion the uterus and pelvic cavity may be inspected abdominally with a laparoscope at the time of surgery.
The patient is taken from the operating theatre to recovery ward and observed for a few hours after the surgery, but can usually be discharged the same day or day after surgery. Often a pain relief injection or suppository is provided during this time and occasionally an anti-vomiting injection is also necessary.
Patients are advised that bleeding from the vagina is normal for two weeks or so after surgery and a brownish discharge may continue for one month. Mild period type cramps are normal in the first ten days or so until bleeding ceases and strenuous physical activity should be avoided for one month.
Patients should not drive for 24 hours and sexual intercourse should be avoided for two weeks after surgery.
Your surgeon may prescribe additional medication to keep the lining of the uterus thin during the healing phase for a short period of time.
Results of Endometrial Ablation
Experience with this technique indicates that 50% of women have no further periods, 40% have only light monthly bleeding, but about 5% show no improvement. In these cases a repeat procedure or alternative operation (e.g. hysterectomy may be suggested. In the last few months there has been concern expressed that younger women having this operation may present five or more years after surgery with a recurrence of bleeding problems.
The advantage of the operation is relief from heavy bleeding without the need to remove the uterus. The operative procedure is minor; hospital stay and convalescence are short, conferring significant practical and economic advantages.
The surgical procedure causes the uterine lining to shrink and replaces the endometrium with a thin layer of scar tissue. Since the ovaries are untouched normal hormonal functioning will continue until the time of natural menopause, therefore the operation will not hasten the onset of hot flushes or mood changes and it should not influence patient weight.
Since the uterus and cervix (neck of the womb) are still present your normal cervical smear regime should be continued.
The procedure will not automatically prevent pregnancy but it is extremely unlikely to occur since the scarring inside the uterus tends to cause infertility. Should a pregnancy occur, however, it is possible that development or growth of the fetus could be disadvantaged. If prior to surgery normal fertility existed, contraception or sterilisation should be discussed with your gynaecologist.
A follow up examination with the surgeon is normally requested after six weeks and further assessments with your gynaecologist or family practitioner may be recommended.
We at the Oxford Clinic encourage patients to discuss forthcoming surgery with their gynaecologist or family practitioner and believe that in doing so their post-operative recovery will be enhanced.