Endometrial Ablation and endometrial resection - Newcastle Hospitals NHS Foundation Trust

What is an endometrial ablation and resection?

Endometrial ablation and resections are both treatments for heavy menstrual bleeding (‘periods’). Transcervical resection of endometrium can also be used to treat infertility (difficulty getting pregnant) if this is caused by an abnormal fibroid or polyp inside in the womb.

An endometrial ablation is a treatment to permanently remove (ablate) the womb lining (*endometrium) using heat.

The procedure can be done using conscious sedation in the Women’s Health Unit or, if needed, under general anaesthetic in an operating theatre.

Transcervical endometrial resection is an alternative where the endometrium is surgically reduced or removed.

The procedure can be done using light sedation in the Women’s Health Unit or, if needed, under general anaesthetic in an operating theatre.

An endometrial ablation is not suitable for everyone. It is permanent and it might not be possible to do if the womb is too large or the shape of the womb is changed due to fibroids. It is not suitable for women who would like another pregnancy.

Pregnancies that occur following these procedures are often associated with complications and may be quite dangerous. A reliable form of contraception is therefore needed to prevent pregnancy.

A Transcervical endometrial resection can also be used to treat infertility if this is due to small fibroids that have grown inside the womb. The aim of treatment is to remove (resect) the fibroids leaving the womb lining (endometrium) intact.

What are the alternatives to an ablation or resection?

Menstrual problems are common and most settle over time or can be treated with medication. Alternative management of heavy menstrual bleeding include:

Non-hormonal tablets (tranexamic acid) to reduce the amount of bleeding when it occurs
Hormonal medications (for example the combined oral contraceptive pill, the depo
provera contraceptive injection
A hormonal intrauterine system (“coil”).

Many people may try these alternatives before considering an endometrial ablation or resection.

Those with persistent problems may consider surgery with an ablation, resection or even a hysterectomy.

A hysterectomy is a major surgery. Please ask your doctor about this if you wish to consider an alternative.

What are the chances of an ablation or resection improving my symptoms?

If done to control heavy menstrual bleeding, an ablation is successful in reducing the amount of bleeding in 9/10 people who undergo the procedure.

More than a half will have little or no periods at all. Many women avoid hysterectomy, or the long term need to take medications to control periods.

A small number of women will find no improvement, and some go on to have a hysterectomy at a later date.

How do I prepare for the procedure?

An ablation or resection can be done with either light sedation in the Women’s Health Unit or under a general anaesthetic in an operating theatre. In both settings it is typically a day case procedure meaning that you will arrive and go home the same day.

Prior to conscious sedation, you will undergo a pre-assessment check. Some women may not be suitable for a sedation procedure. Please let the medical and nursing staff know of any medical conditions when you book your treatment.

Because of the small risk of vomiting whilst under sedation, you are advised to have no food in the six hours before the planned start time of the procedure. You are able to drink clear fluids (water, squash or milk-less tea or coffee) until two hours before the procedure. You can take your usual medications with a sip of water.

We would advise you to take a pain killer before you attend as this helps your recovery.

Any suitable painkillers can be taken such as paracetamol alone, paracetamol and codeine, ibuprofen or any similar non-steroidal pain killer. You must inform the nurse when you attend the clinic what you have taken and when.

Endometrial or fibroid resection are more effective if the womb lining is thinned out and fibroids reduced in size prior to surgery. This is achieved by an injection (Prostap or Zoladex) given a month prior to surgery (sometimes additional doses are given). In most cases your GP surgery can administer this. The injection will often cause temporary menopausal symptoms during its use but symptoms do resolve.

Who will see me on the day?

You will meet a number of people on the day including a gynaecologist, specialist nurses, and an anaesthetist. As we are a large teaching hospital you are also likely to meet trainee doctors and nurses. When you arrive at the clinic, you will be seen by a nurse who will ask some simple questions about yourself and take some measurements, including your height and weight.

Anyone who has an endometrial ablation or resection needs to sign a consent form to give permission. Your nurse or doctor will explain the procedure in full and discuss the possible side effects.

Are there any side-effects or risks of a endometrial ablation or resection?

Endometrial ablation and resection are commonly performed and generally safe procedures. In order to be able to give consent, anyone deciding whether to have this procedure needs to be aware of the possible side effects and the risk of complications. Your doctor will be able to explain how the risks apply to you.

Side effects during and immediately after the procedure are common but are usually mild and temporary.

Side effects

Abdominal pain, often described as similar to period pain
Vaginal bleeding for several days, although, occasionally, bleeding and discharge can
continue for up to one month.

Complications are unexpected problems that can occur during, or after, the procedure. Most
people are not affected.

Risk of complications

An unexpected reaction to the anaesthetic.
Infection is uncommon but can occur. If you have an infection after surgery, you are likely to notice worsening pain or bleeding, your GP will be able to treat most cases with antibiotics. If problems persist you should be referred back to hospital.
Damage (‘perforation’) of the womb occurs in less than 1% of patients. If this did happen then in the majority of cases a period of observation is all that is needed. There is however a very small risk of damage to surrounding organs and it therefore may be necessary to stay on hospital to have a laparoscopy (key-hole surgery) or laparotomy (open abdominal surgery) if damage is suspected. This is very rare.
The fluid put inside the womb during an endometrial resection procedure can be
absorbed into the blood stream. A rare complication of this is ‘fluid overload’ where the levels of fluid and salts in the blood stream change. If this did occur, a period of observation to monitor blood test levels is all that is needed. Very rarely patients may experience breathing difficulties and seizures (less than 1 in 1000 cases).
Heavy bleeding can occur during or immediately after surgery. Rarely a hysterectomy is needed to stop the bleeding (less than 1 in 500 cases)

What to expect after an endometrial ablation or resection?

You should recover from the sedation very quickly and will probably be able to go home after a short rest – often within one to two hours. Occasionally a longer recovery is needed, and patients may be transferred to a ward for this.

Sometimes, women find that they have some pain after the procedure. This happens after a general anaesthetic as well as after a sedation procedure. The nurse looking after you can give you more painkillers to make sure that you are comfortable. The nurse will also complete some checks before you go home.

Before you leave the hospital, the doctor / nurse will explain the findings of the procedure or will make a further appointment to do this. If a biopsy has been taken, it may be three to four weeks before the results are available.

When discharged, it is important that a responsible adult accompanies you. You are advised to go home by car or taxi. As with all surgical procedures, you should have a responsible adult stay with you overnight.

Once home, simple pain relief may be taken if needed. Some women feel ready to resume normal activities and work the day after the procedure, others may need to take longer but rarely more than one to two weeks.

After vaginal procedures, light bleeding or spotting for a few days is normal. Some women find that the first period following the procedure is heavier or more prolonged than usual. To help avoid the risk of infection, avoid tampons for at least one week after the procedure.

Sexual intercourse should be avoided until bleeding stops.

Most women experience no medical problems following conscious sedation / minor gynaecological procedures. The hospital or a GP should be contacted immediately if you have any concerns.

The following symptoms may indicate an infection or a complication

Persistent heavy bleeding
Pain that persists for more than 48 hours
Swollen abdomen or general abdominal pain
High temperature or fever

Your GP will be able to help in most cases. If, however, you cannot reach your GP, staff at the
Women’s Health Unit or our Gynaecology Ward may be able to offer advice over the telephone.

Women’s Health Unit

Monday to Friday 8:30am to 5pm

0191 282 0140

Ward 40

24 hours

0191 282 5640

Do I still need cervical screening smear tests?

The cervix is not removed or changed during an ablation or resection so cervical smears will still be needed. If you use HRT you must take a combined (oestrogen and progesterone) preparation.

Research

At the RVI, we have a large research team and often work with Newcastle University. All of our consultant team are actively involved in research and may discuss the possibility of you getting involved in research at any of our clinics.

Whilst we are very grateful for those who choose to participate, this is not essential and please feel free to decline. This will not affect your care.

What if I cannot attend my appointment?

If you are unable to attend your appointment, please let us know.

Contact

Call our secretarial team.

0191 282 5031

For further information

PALS (Patient Advice and Liaison Service) for help, advice and information about NHS services. You can contact them on freephone 0800 032 02 02, email [email protected].