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Having endometrial ablation

Your specialist has recommended that you have a treatment on the lining of your womb called endometrial ablation. This leaflet provides some standard information and advice about the procedure. However, you should always follow the instructions of your own specialist.

If you have any unanswered questions or concerns, please do not hesitate to ask your specialist or nurse for more information. It is natural to feel anxious, but knowing what to expect can often help.

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.  

Endometrial ablation is a surgical treatment to remove part of the womb lining (endometrium) for women who have heavy menstrual bleeding, known as menorrhagia.

If you have heavy blood loss each month this can lead to a lack of iron in the blood (anaemia) making you feel tired and generally unwell. If medications cannot reduce your
menstrual bleeding then your doctor may suggest endometrial ablation.

This treatment is not recommended if the bleeding is due to growths in your womb (fibroids). Its also not suitable for women who may want to have children in the future, as it affects fertility.

Endometrial ablation is usually performed under a general anaesthetic. This means you will be asleep throughout the procedure. For more details on general anaesthesia, please see the separate leaflet.

The procedure is often carried out as a day case, with no overnight stay. Alternatively you may need to stay in hospital overnight.

Once at the hospital, you may be asked about your medical history and any previous experience of hospital treatment. Your answers will help them in planning your care whilst you are in hospital.

Before you come into hospital, you will also be asked to:

  • Take medication for a month or two prior to the procedure to shrink the lining of your womb. Side effects of the tablets include vaginal dryness, hot flushes and night sweats,
  • Have a bath or shower at home on the day of your admission,
  • Remove any make-up, nail varnish and bulky or sharp jewellery. Rings and earrings that you would prefer not to remove can usually be covered with adhesive tape,
  • Follow the fasting instructions in your admission confirmation letter. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

When you arrive at the hospital, a nurse will explain how you will be cared for during your treatment. Your specialist and anaesthetist will also visit you. This is a good time to ask any outstanding questions about your treatment.

The nurse will help you prepare for theatre and will do some simple tests such as taking your blood pressure and pulse, and may ask you for a urine sample. You may be asked to wear compression stockings to help prevent blood clots forming in the veins of your legs.

Consent

You will be given a consent form to sign. By doing this, you confirm that you understand what the procedure involves, including the benefits and risks, and give your permission for it to go ahead.

Please see the back of this leaflet for further information about the possible side-effects and complications of this procedure. You need to know about these in order to give your informed consent.

About the operation

After the anaesthetic has taken effect, a telescope called a hysteroscope is inserted through the vagina and into your cervix so that your specialist can view the womb. Special instruments are then used to remove the womb lining. There are a variety of methods:

  • Electrocautery, also known as diathermy – the lining is burnt off using a low-voltage electric current through a wire or probe,
  • Loop electrosurgical excision procedure (LEEP) – this is similar to electrocautery, but the wire or probe has a loop on the end to remove the lesion,
  • Laser surgery – a beam of light destroys the lining,
  • Hot fluid – this can be pumped into the womb, either directly or by using a balloon-like device, to destroy the lining.


The procedure usually lasts about half an hour.

You will be taken from the operating theatre to the recovery room, where you will come round from the anaesthetic under close supervision. After this, you will return to your room.

Back on the ward

A nurse will make you comfortable, and monitor your blood pressure and pulse at regular intervals. You will be wearing a sanitary towel, as you will have some vaginal bleeding.

You will need to rest until the effects of the anaesthetic have passed. You may feel discomfort similar to period pain and will be given painkillers that can usually be taken every four to six hours. If you continue to feel pain, please discuss this with your nurses or doctors.
When you feel ready, you can begin to drink and eat, starting with clear fluids such as water or apple juice.

Going home

If your operation has been planned as a day case, you will be able to go home once you have made a full recovery from the anaesthetic. However, you will need to arrange for someone to drive you home and then stay with you for the first 24 hours.

Before you are discharged, the nurse will give you a contact telephone number for the hospital, in case you need to ask for any further advice. You will be given a follow-up outpatient appointment with your specialist for two to six weeks after your operation.

After you return home

If you need them, continue taking painkillers as advised. A general anaesthetic can temporarily affect your co-ordination and reasoning skills, so you should avoid driving, drinking alcohol or signing legal documents for 24 hours afterwards.

In most cases you can expect to go back to work or resume your normal activities within a few days.

You should expect some light vaginal bleeding for up to a month after the procedure and should use sanitary towels rather than tampons. If the bleeding becomes heavy you should contact the hospital.

About half of women who have this operation stop having periods. In others their period becomes lighter. It can take up to three months to see whether the operation has been successful.

If you are of childbearing age you will need to use contraception, as it is still possible for you to become pregnant.

Endometrial ablation is a commonly performed and generally safe surgical procedure. For most women, the benefits in terms of improved symptoms are greater than the disadvantages. However, all surgery does carry some element of risk. This can be divided into the risk of side-effects and the risk of complications.

Side-effects

These are the unwanted but mostly temporary effects of a successful treatment. Examples of side-effects include feeling sick as a result of the general anaesthetic, although medicines are available to help avoid this.

You are likely to feel some discomfort similar to period pain after the operation. You will also have some vaginal bleeding after the operation, similar in amount to a normal period. This may last for up to a month.

Complications

This is when problems occur during or after the operation. Most women are not affected. The possible complications of any surgery are excessive bleeding during or very soon after the operation, infection, and an unexpected reaction to the anaesthetic. It is also possible to develop a blood clot in the veins of one of the legs (deep vein thrombosis, or DVT).

Specific complications of endometrial ablation include the womb or bowel being punctured during the operation. This is very rare. If it occurs further surgery may be required.

About 90 per cent of women find that endometrial ablation improves their heavy periods. Others may need a repeat of the procedure or alternative treatment.

The chance of complications depends on the exact type of operation you are having and other factors such as your general health. You should ask your specialist to explain how these risks apply to you.

 

American College of Obstetricians and Gynaecologists
http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZNH26CEAC&sub_cat=9

WebMD
http://my.webmd.com/content/healthwise/138/34440

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