Endometrial ablation surgery

Endometrial ablation surgery is a procedure that destroys the endometrium, which is the lining of your womb. The womb’s lining breaks down and sheds each menstrual cycle. By destroying the endometrium, endometrial ablation aims to reduce heavy menstrual bleeding. 

The procedure is usually carried out using a hysteroscope (a long, thin telescope) inserted through your vagina and into the cervix. Small surgical instruments are then used to destroy or remove the womb’s lining. This method means your doctor won’t need to make any cuts on your tummy to access your womb.

Reasons for having endometrial ablation surgery

Doctors may offer you endometrial ablation surgery if you have heavy periods that are affecting your day-to-day life. 

Heavy periods (menorrhagia) 

Heavy periods, also known as menorrhagia, can be caused by a variety of factors. For example:

• Adenomyosis — where the lining of the womb grows into the muscles in the wall of the womb, leading to an enlarged womb
• Bleeding disorders or problems with your thyroid
• Endometriosis — where cells similar to the ones in the lining of your womb grow in other parts of your body
• Fibroids — non-cancerous growths in or around your womb
• Hormonal changes or imbalances — these are more common as you near perimenopause
• Medications — eg certain blood-thinning medicines
• Polyps — small growths in the lining of your womb, or your cervix

Your consultant will look at how your heavy menstrual bleeding is affecting your quality of life, as well as if it’s causing or contributing to you developing anaemia (low red blood cells). They’ll also look at whether your symptoms have improved with other treatments, such as medication or a hormonal coil.

Is endometrial ablation surgery right for you? 

Your doctor may recommend endometrial ablation surgery if:

• You have heavy menstrual bleeding and don’t want to become pregnant in the future
• Other treatments have either not worked or aren’t suitable for you

It may not be right for you if:

• You have an active pelvic infection
• You have certain womb conditions (your consultant will discuss these with you)
• You have or are at increased risk of womb cancer
• You plan to become pregnant in the future

Endometrial ablation, pregnancy, and fertility

Endometrial ablation reduces your chances of getting pregnant. Becoming pregnant after the procedure is usually unlikely, but it can still happen. Pregnancy after endometrial ablation can carry serious risks (including miscarriage and ectopic pregnancy) so you should still use contraception.

Alternative treatments to endometrial ablation

Alternative treatments to relieve heavy periods include:

• Contraceptive injections and implants
• Hormonal oral medications like contraceptive pills or progesterone pills
• Hormonal coil 
• Injections like GnRH to induce medical menopause
• Non-hormonal oral medications such as tranexamic acid or mefenamic acid

A long-term permanent solution is a hysterectomy, which is the surgical removal of your womb.

Types of endometrial ablation surgery

Common methods of performing endometrial ablation surgery include:

• Electrosurgery (wire loop/probe) and laser — energy is used to remove/destroy the lining
• Heated balloon — this destroys the lining using a soft balloon that’s placed in the womb and filled with warmed fluid
• Heated fluid/hydrothermal ablation — heated fluid circulates in the womb for around 10 minutes to destroy the lining
• Radiofrequency ablation — a small mesh/probe uses controlled electrical energy inside the womb to destroy the lining

The procedure will begin with a hysteroscope being inserted through your vagina so your medical team can inspect the inside of your womb. They’ll gently open your cervix to insert the hysteroscope into your uterus. They may use sterile fluid to allow them to see clearly. Sometimes, your doctor may take a small sample of your womb lining to send off for testing (a biopsy). 

Your consultant will discuss each of the endometrial ablation methods with you and decide the most appropriate one based on the shape of your womb and your symptoms.

How to prepare for endometrial ablation surgery 

Before you have your surgery, you’ll need to complete a pre-admission form. This allows your medical teams to plan appropriate care for you. They will ask about:

• Allergies
• Any medications that you take
• Any support you need with your daily activities
• Smoking status and history
• Who you live with
• Your weight

Pre-admission clinic

Some people may need to come into the hospital a few days before their surgery to see the specialist pre-admission nurse. If you need to come in, bring any medication you take and its packaging. This includes prescribed and over-the-counter medications. You should also tell the nurse about any allergies you have.

If your consultant has requested any special tests, such as X-rays or blood tests, these will be arranged during your pre-admission review. This is also an opportunity to ask any questions you may have.

Preparing for the operation

Most people have the procedure under general anaesthetic, so you’ll need to fast for at least 6 hours before the surgery. This means no food or drink, chewing gum, or smoking. You can drink still water up to 2 hours before your operation. The exact timings for your fast will be in your admission letter.

Who will be involved?

Your care team will likely include:

• A consultant gynaecologist — an expert specialising in womb, ovarian and reproductive health, who performs the procedure
• A specialist nurse — to support you before and after treatment
• A skilled anaesthetist — to manage your anaesthetic and monitor you throughout
• Theatre and recovery staff — to look after you during and after the procedure

At Spire Healthcare, you can choose your consultant from a team of experienced specialists working in modern, well-equipped hospitals. Our consultants meet high standards and often hold specialist posts within the NHS, delivering expertise in complex sub-specialty surgeries. Many of our consultants are recognised internationally for their research in their specialised field.

The procedure

Before your surgery, your medical team will confirm your details and perform basic checks, such as your temperature and blood pressure. You’ll be asked to sign a consent form confirming you understand why you need the operation and what it involves.

You’ll change into a hospital gown and wear disposable underwear.

How long does the procedure take?

The surgery itself usually takes between 15 and 30 minutes, depending on the method used. However, you also need to allow more time before and after for anaesthetic, preparation and recovery.

Anaesthetic choices 

Endometrial ablation usually happens under:

• General anaesthetic — you’ll be asleep during the procedure
• Local anaesthetic, either with or without sedation (“twilight”) — local anaesthetic numbs the cervix, and sedation can help you feel physically and mentally relaxed; you may not remember the procedure

Your anaesthetist will discuss the safest option for you.

Pain during surgery and straight after surgery

The anaesthetic means you shouldn’t feel any pain during the operation. You’ll likely have some abdominal pain for 24 to 48 hours after the procedure that may feel like period pain. You should be able to manage your pain with over-the-counter painkillers such as paracetamol or ibuprofen. 

If you experience severe pain in your lower abdomen or heavy bleeding, seek emergency medical attention.

What happens straight after surgery 

If you have general anaesthetic or sedation, you’ll be looked after in recovery until you’re fully awake, although you may still feel sleepy. Some people feel sick for up to 24 hours after a general anaesthetic. You’ll usually be discharged when you’ve eaten and had something to drink, walked around a little, and have been to the toilet.

Your hospital stay

Most people can leave the hospital the same day, but occasionally an overnight stay is needed (eg if your procedure is later in the day).

Most people are back to their normal activities within a few days. However, recovery varies for each individual. Follow your care team's guidance, and contact the hospital if you’re worried about your symptoms.

Managing your recovery at home

• Vaginal bleeding and discharge – Most people experience dark vaginal bleeding for several days, which should reduce to a discharge and lessen over time. Use sanitary pads rather than tampons to reduce the risk of infection
• Sexual activity – You should avoid having sex until you feel comfortable and any bleeding or discharge has settled
• Urination – You may find you need to pass urine more frequently in the first 24 hours after your surgery. This is normal and is not cause for concern
• Driving – Avoid driving on the day of a general anaesthetic or IV sedation; ask someone to pick you up after your surgery. You should only return to driving when you can comfortably perform an emergency stop and can manoeuvre your vehicle safely
• Exercise – You can take gentle exercise, such as short walks, the day after your procedure. Avoid heavy lifting or rigorous exercise for the first 48 hours, and wait for any bleeding and vaginal discharge to stop before resuming swimming. Most people can return to their usual exercise routines in 1–2 weeks
• Time off work – Many people return to work in 2–3 days, depending on how they feel and the type of work they do. If you have a more physical job, it may take longer before you feel up to returning to work

What you can do to reduce your risk of complications

• Smoking – Stopping smoking can help reduce your risk of developing complications and can support your recovery
• Fitness – Consider improving your cardiovascular fitness before your operation to help speed your recovery afterwards. Even 10–15 minutes per day can significantly improve your outcome
• Weight reduction – Individuals who are overweight or obese typically have higher rates of complications after surgery. If you can reduce your weight to a healthy range before your surgery, it will support your recovery

Complications are uncommon, but you should know what to look out for. There are some risks associated with any surgery: 

• Deep Vein Thrombosis (DVT), also known as a pulmonary embolus — a blood clot in the veins of your leg, which can be serious if it travels to your lungs
• Low risk of bleeding during or soon after the operation — your medical team will monitor your blood pressure and pulse to detect it

Risks specific to endometrial ablation

• Cervical tear — this may need a surgical stitch to close it
• Haematometra — trapped blood behind scar tissue, causing cyclical pain
• Infection of the womb/pelvis — you may experience foul-smelling discharge and generally feel unwell
• Incomplete procedure — you may need a second operation
• Uterine perforation — a small hole made by instruments; may rarely involve bowel or bladder injury

Anaesthetic risks

Anaesthesia is generally considered safe, but side effects can include nausea, vomiting, dizziness, and headache. More serious complications are rare.

When to seek urgent help

Seek medical advice if you develop:

• Difficulty passing urine
• Fever (38°C or above)
• Heavy, persistent bleeding
• Foul-smelling vaginal discharge
• Unexplained cough, shortness of breath or chest pain
• Unexplained swelling in your calf