Endometrial ablation

Endometrial ablation is the removal or destruction of the lining of the womb. It is an alternative to hysterectomy for many women with heavy periods (menorrhagia) who wish to avoid major gynaecological surgery. It is generally performed as a day-case procedure and most women return to normal daily activities within a couple of days. Increased vaginal discharge for 2-4 weeks is normal as the lining of the womb is shedding. Intercourse, tampons and strenuous activities should be avoided for about 2 weeks. Endometrial ablation may not suit all women. An ultrasound scan and diagnostic Hysteroscopy should be done before the ablation to check that the cavity of the uterus before a decision can be made.

Transcervical Resection of the Endometrium (TCRE) can be performed using a special hysteroscope (telescope) called a resectoscope. This instrument allows visualisation of the cavity of the womb and has a built-in wire loop or roller-ball that uses  electrical energy to cut or coagulate tissue under direct vision. The procedure is carried out under general anaesthesia and takes approximately 20  minutes. You may be advised to take some injections for 2-3 months before the procedure in order to thin down the lining of the womb. Approximately 85% of women experience relief of their symptoms within the first few months, with many having scanty or absent periods after the procedure.

Other methods of ablation are also available. The NovaSure endometrial ablation involves  inserting a slender wand into the uterus, which is extended into the uterine cavity as a triangular mesh. The mesh gently expands, fitting to the size and shape of your uterus. Precisely measured radio frequency energy is delivered through the mesh for 60-120 seconds. The mesh device is pulled back and removed from the uterus. The procedure can be done with or without anaesthetic as a day case.

The risks of endometrial ablation procedures are rare and include perforation of the womb, infection, pelvic pain, bleeding, excess fluid absorption, injury to pelvic and abdominal organs.

Since endometrial ablation will destroy the lining of the womb, which is essential for embryo implantation and establishment of pregnancy, ablation of the endometrium should not be offered to women who wish to maintain their fertility. It also should not be performed to women with pre-malignant or malignant conditions of the womb, and in women with  pelvic inflammatory disease (PID). You are advised to use a very effective contraception after endometrial ablation because pregnancy after the ablation is possible and carries higher risks of miscarriage, preterm labour and injury to the fetus.

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