Women and Children – Obstetrics and Gynaecology
Even if your consultant has told you about your treatment, many of us do not take in everything mentioned in the clinic. This booklet is to help you understand your condition and the reason for the treatment you are going to have.
As we are all different, it is not possible to personalise this information, so there may be differences between your individual case and the information given here.
What is endometrial ablation?
Endometrial ablation is a procedure to destroy the lining of the uterus (womb). As a result of the ablation periods either stop or reduce so that your periods become more manageable and acceptable.
Endometrial ablation is NOT a contraceptive procedure so it is recommended that you have in place an ongoing method of contraception until menopause. This should be discussed with the doctors and nurses in clinic at your appointment.
Pregnancy can occur after endometrial ablation. If it does, the risks of miscarriage and other complications to the mother and the baby are greatly increased.
If you might wish to become pregnant in the future, you should not have this procedure.
Why do I need an endometrial ablation?
The uterus (womb) is lined by a layer of tissue called endometrium which bleeds every month in response to the changing levels of hormones produced by the ovaries.
Some women have very heavy, frequent or very long menstrual periods which can be due to a variety of causes including polyps, fibroids or excessive thickening of the womb lining. The medical term used for heavy menstrual periods is menorrhagia.
Are there any alternatives to endometrial ablation?
Menorrhagia can be treated by drug therapy and there are various drug treatments used to control menstrual loss.
- Hormone preparations
Contraceptive pill, progestogen tablets, Depo injections or hormone replacement therapy
- Non-hormonal preparations
Tranexamic acid or Mefenamic acid which reduce the blood flow
- Intra-uterine hormonal device
Mirena or Levosert IUS
What will happen at the treatment clinic?
Because you wish to stay awake and have a local anaesthetic for your procedure, you have been referred to the outpatient treatment clinic held at the Friarage Hospital in Northallerton.
You will be well supported by the staff in a relaxed and friendly environment and you are also welcome to bring a friend or relative with you.
On arrival you will be seen by a member of the team. They will review your history, explain your procedure in detail and answer any questions that you may have. You will then be required to sign the consent form.
After this time we will ask you to change ready for the treatment, you need only remove your lower clothing and a gown or sheet will be provided for your modesty.
- We suggest that you have your breakfast or lunch before you attend for your treatment.
- Please arrange for someone to bring you and drive you home.
Please note carefully:
If you are on a period it is often not possible to perform this treatment therefore we recommend if you are bleeding at time of appointment to cancel and re book.
How is endometrial ablation performed?
A hysteroscope is passed through the vagina and cervix (neck of the womb) into the cavity of the uterus.
The hysteroscope is a fine telescopic instrument which is connected to a camera and a television system so that the hysteroscopist (doctor or nurse) can see the inside of the uterus to confirm treatment is possible. You may also watch the TV screen if you wish to.
We may inject, using a needle that passes through the hysteroscope, some local anaesthetic is injected into the muscle at the top of the womb. This helps to reduce the discomfort of the procedure.
A local anaesthetic ‘block’ may then be injected into the cervix before the ablation device is passed into the uterus.
There are two different devices for endometrial ablation currently in use at The Friarage Hospital outpatient treatment clinic:
- ‘Novasure’ …. a heated mesh
- ‘Minitouch’ …. a microwave device
Once the device is in position some final checks will take place then the treatment will start. It lasts for approximately two minutes and may give you a feeling like a period pain or a contraction.
After the ablation, the hysteroscopist will usually have a look back inside the uterus with the hysterocope to check if the whole of the cavity has been treated.
What are the risks with endometrial ablation?
Risks of endometrial ablation include:
- Pain, bleeding or infection
- Heat damage to nearby organs
- A puncture injury of the uterine wall from surgical instruments
If ablation does not control heavy bleeding, further treatment or surgery may be needed.
What happens when I go home?
- The pain relief and local anaesthetic blocks you were given to help you during the treatment will begin to wear off and it is important you take regular painkillers to prevent the build-up of pain and keep yourself comfortable during the first three days.
You can take Paracetamol or Codeine three to four hours after your treatment but if we have given you Diclofenac at the clinic you should not have another dose of Ibuprofen until 16 hours after the procedure.
- Additional measures such as a hot water bottle or a warm bath can help if you have a period pain-like discomfort
- You may have a bath or shower, as preferred, and as soon as you wish after the operation. There is no need to alter your normal hygienic procedures.
- None of the medication you have been given will affect your ability to drive, operate machinery or drink alcohol but we advise that you spend the remainder of the day quietly at home.
- You should rest for one or two days following endometrial ablation but should be able to resume normal activities after two to four days. Returning to work is up to the individual concerned. You are the best judge of how you are feeling.
- You can expect a watery discharge, mixed with blood, for a few weeks. The discharge is typically heaviest for the first few days after the procedure.
- You may need to pass urine more often during the first 24 hours after endometrial ablation but this does not mean you have an infection.
- Because of the risk of infection, it is advisable not to go swimming, use tampons or have penetrative sex until your discharge has settled after the operation.
If you have any of the following symptoms, you should contact your GP
- Vaginal bleeding, which is heavy and fresh, bright red or the passing of clots
- Pain which is severe and not controlled by your recommended painkillers
- A smelly vaginal discharge
- Feeling unwell, hot and feverish
We hope you have found this information helpful. Please remember our staff will be happy to answer any questions you have about any aspect of your care and welcome any comments about this leaflet.
Contact the Friarage Hospital
All information contained in this booklet, as advised by: The Gynaecology Medical and Nursing Team at The James Cook University Hospital.
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.