An Introduction To Endometrial Ablation

  • Since the late 1980s, some gynaecologists have been removing or destroying the endometrial lining of the womb (endometrial ablation).
  • The advantage of this new technique is that patients are only in hospital for one or two days and are often back to work after two or three weeks.
  • Following endometrial ablation, the majority of patients experience reduced blood loss.
  • However, at least 70% continue to have periods and even the most successful and experienced surgeons have shown that 20-25% of their patients will require a second operation (repeat endometrial ablation or hysterectomy) within two years.
  • Endometrial ablation may not destroy all the endometrium so that sterilisation is not guaranteed and contraception is still required.
  • Endometrial ablation is generally only recommended if there is dysfunctional uterine bleeding (No cause such as fibroids).
  • Patients must have an endometrial biopsy before the endometrial ablation.
  • There has been no reduction in the incidence of hysterectomy resulting from the introduction of endometrial ablation suggesting that ablations are additional procedures to hysterectomy rather than a replacement.
  • If heavy menstrual bleeding does not respond to medication, and your family is complete, your doctor may suggest endometrial ablation.
  • It does not remove the uterus. The main advantage of endometrial ablation is that the uterus is conserved.
  • Endometrial ablation is a relatively minor procedure compared to hysterectomy.
  • Endometrial ablation is provides ahysterectomy alternative for many women with heavy uterine bleeding who are wish to avoid major surgery.
  • Endometrial ablation is an attractive option for women who would have required hysterectomy but who have serious medical problems making major surgery dangerous.

The late effects of endometrial ablation are not known. We do not know how women having endometrial ablation will be affected when they go into their fifties, sixties, seventies and eighties: It will take another forty or fifty years before we have the answers.

After endometrial ablation, some women still have light bleeding or spotting which may persist for several weeks. Many women may have regular periods following endometrial ablation. This is because the ovaries and uterus are conserved during the endometrial ablation. If endometrial ablation does not control heavy bleeding, further treatment or surgery may be required.

Most women cannot conceive after endometrial ablation. You should, however, continue to use some form of birth control until after menopause. You also may want to think about sterilization as an option to prevent pregnancy.

Endometrial ablation does not affect sexual response.

A woman who has had endometrial ablation has all her reproductive organs in place. Because of this, routine Pap tests and pelvic exams are still needed after endometrial ablation.

Endometrial ablation is not recommended if you have a high risk for endometrial cancer such as severe endometrial hyperplasia.

The Procedure

  • Endometrial ablation is a short procedure and this is one of its advantages as a hysterectomy alternative. It is frequently performed as outpatient surgery in most cases. This means you can go home the same day.
  • You will be given some form of pain relief or sedative to help you relax before the procedure. The type of pain relief used depends on the type of endometrial ablation procedure, where it is done, and your wishes. 
  • There are no incisions (cuts) involved in endometrial ablation.
  • There are several techniques for ablating the endometrium.

Electrical (Diathermy) Endometrial Ablation

A loop or rollerball tool can be used to ablate the thin endometrial lining of the uterus. For the procedure, the walls of the cervix are dilated to allow passage of a device called a hysteroscope. The doctor looks through it to see the inside of your uterus on a monitor screen. Your uterus is filled with fluid to expand it. Then, the ball or loop is pulled across the endometrial surface. The rollerball or loop applies an electric current to the surface as it is pulled across the lining. This current destroys the endometrial lining.

Laser Endometrial Ablation

A laser device burns the lining using a high-intensity light beam. Like electrical endometrial ablation, the laser reaches the lining of the uterus through the hysteroscope. The laser then ablates the endometrial lining.

RadioFrequency Endometrial Ablation

The bipolar radioFrequency endometrial ablation system (NovaSure?) has been developed to treat women suffering from menorrhagia due to dysfunctional uterine bleeding. This technology allows for a customized, controlled, contoured endometrial ablation, without the need for hysteroscopic visualization. Average treatment time for radioFrequency endometrial ablation is 90 seconds. Active bleeding, at the time of treatment, is not found to be a limiting factor for the use of this type of endometrial ablation. There is some indication that the NovaSure bipolar radio-Frequency endometrial ablation offers slightly better results than the Thermachoice balloon endometrial ablation.

Thermal Endometrial Ablation

With thermal ablation, a device or fluid is inserted into your uterus. Heat and energy are applied to increase the temperature and destroy the lining.

My own preference is to use a special fluid filled latex balloon which is heated in a controlled manner for eight minutes (Figure 24.5). Special training is required for hysteroscopic surgery, and their is a learning curve, whereas the latex balloon technique is remarkably simple to use. The majority of women having balloon (Thermachoice) as a menorrhagia treatment would prefer to have it performed in the outpatient setting.0801

Endometrial Ablation

Figure 24.4 Balloon Endometrial Ablation

Risks of Endometrial Ablation

There is some risk involved with every surgical procedures.

The endometrial ablation procedure has certain risks.

  • The device used may perforate through the uterine wall damaging adjacent structures such as the bowel.
  • Rarely, the fluid used to expand your uterus, for laser endometrial ablation or diathermy electrical ablation, may be absorbed into your bloodstream. This may allow too much fluid in your body and can be serious.

After the Endometrial Ablation

Some minor side effects are common after endometrial ablation:

  • Cramping, like menstrual cramps, for 1-2 days
  • Small amount of thin, watery discharge mixed with blood, which can last a few weeks
  • frequent urination for 24 hours
  • Nausea

In most cases, you can expect to go back to work or to your normal activities within a day or two of your endometrial ablation.

Effectiveness of Endometrial Ablation

About 90% of women will have reduced menstrual flow following endometrial ablation, and 50% will stop having periods.

Younger women are less likely to respond to endometrial ablation. After an endometrial ablation, younger women are more likely to continue to have periods and could need a repeat procedure.

Related Medical Abstracts - Click on the paper title:-

Hysterectomy and Endometrial Ablation Compared

  • Ablation has the advantage of speed of recovery. If patients are advised before admission for hysterectomy that early discharge home is likely, all domestic arrangements can be made.
  • For those women who feel that they need surgical treatment for their heavy periods but who are reluctant to lose their uterus, the ablation techniques are attractive.
  • Even with relatively short follow-up, it has become apparent that a significant number of patients undergoing ablation require further surgery. This means that the overall difference between hospital admission times between ablation and hysterectomy may be less than original estimates and this is also true when comparing economic differences.
  • The risks of surgical procedures in general, and hysterectomy in particular have been presented (surgery risks and Q 24.21). Complications can occur with ablation particularly if the uterus is inadvertently perforated (punctured).
  • In a randomised trial between hysterectomy and transcervical resection (ablation), the effect on health related quality of life at an average of 2.8 years after surgery was evaluated. Those women allocated to hysterectomy had better scores in seven out of eight parameters. The greatest difference was for pain. Twenty eight per cent of those allocated to endometrial resection required a second resection or hysterectomy.0701
  • Endometrial resection is less likely to be associated with urinary incontinence than hysterectomy.

Related Medical Abstracts - Click on the paper title:-

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Women's Health

This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

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