Endometrial ablation is an effective treatment for heavy periods (menorrhagia).
Heavy periods can affect many aspects of your life, including your emotional health and physical health. It can also increase your risk of developing iron deficiency anaemia, a condition where you don't have enough red blood cells to transport the oxygen around your body. This can make you feel tired and breathless. For more information about heavy periods, see our frequently asked questions.
If you have heavy periods, one way of reducing the amount of blood you lose each month is to remove some of the lining tissue of your womb. Endometrial ablation may stop you having periods altogether, or they may become lighter.
An alternative treatment for heavy periods is to have an intrauterine system (IUS) placed in your womb. This is a plastic T-shaped device that releases a hormone similar to progesterone and works for up to five years. It works by thinning the lining of your womb and reducing the bleeding.
Other options include medicines such as the combined oral contraceptive pill or tranexamic acid. These options may be recommended by your GP before you discuss endometrial ablation.
Before endometrial ablation was developed, women who had heavy periods were usually offered a hysterectomy to remove their womb. This is used less often now because you're more at risk of complications during and after a hysterectomy compared with endometrial ablation. It’s not suitable for some women with heavy periods to have an ablation (for example, if you have large fibroids – these are non-cancerous growths of the womb), in which case a hysterectomy may be necessary.
Becoming pregnant after having endometrial ablation is unlikely, but still possible. However, you’re at an increased risk of miscarriage and other complications, which means you shouldn’t have endometrial ablation if you would like to have children in the future. You will need to use contraception after the treatment until you have been through the menopause. If you want to have children, talk to your GP about other treatment options.
For more information about whether endometrial ablation may or may not be suitable for you, see our frequently asked questions.
Your surgeon will explain how to prepare for your endometrial ablation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest infection, which can slow your recovery.
Your surgeon may prescribe medicines, such as nafarelin (Synarel) or goserelin (Zoladex), for you to take for up to eight weeks before your operation. These help to thin the lining of your womb. This makes the treatment more effective and may reduce the amount of bleeding you have during the operation. These medicines can cause side-effects – speak to your surgeon about how these may affect you.
Endometrial ablation is usually done as a day-case procedure, which means you can go home the same day. Depending on the type of ablation you have, you may have the operation done under either local or general anaesthesia. Local anaesthesia completely blocks feeling in the neck of your womb (cervix) and you stay awake during the procedure. General anaesthesia means you will be asleep during the operation. You may also be given medicines just before the procedure, such as misoprostol (Cytotec), to make it easier to insert the instruments into your womb during the operation.
If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice. At the hospital, your nurse may check your heart rate and blood pressure, and test your urine.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.
You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.
Endometrial ablation usually takes about 30 to 45 minutes, including the time needed for anaesthesia and for waking up after the procedure.
There are a number of different types of endometrial ablation. For some of the techniques, your surgeon will pass a thin camera called a hysteroscope in through your vagina and cervix so that he or she can see inside your womb.
Your surgeon will then use special instruments to destroy or remove the lining of your womb using one of several methods. The main ones are listed below.
If you have general anaesthesia, you will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.
You will need to wear a sanitary towel as you will have some vaginal bleeding.
You will usually be able to go home when you feel ready. Your nurse may give you a date for a follow-up appointment. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.
If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen, or you may be given pain relief before leaving the hospital. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, please contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.
You should be able to get back to your usual day-to-day activities about a week after your operation. You may have some vaginal bleeding for a few days and a watery discharge for up to three to four weeks. If your discharge becomes smelly or changes in colour, or if you have pain and feel unwell, contact your GP for advice because you may have an infection.
Follow your surgeon's advice about how long to wait before having sex.
Use sanitary towels rather than tampons after having an endometrial ablation, to help lower your risk of infection. Your surgeon will tell you how long you need to wait before using tampons.
It can take a few months to see whether the operation has been successful. Your first period may be heavier than usual, but this doesn’t mean that the procedure hasn’t worked. Most women have lighter periods after the procedure, while some will stop having periods altogether. See your GP or surgeon if you start to have heavy periods again.
As with every procedure, there are some risks associated with endometrial ablation. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. You may feel sick or be sick after your operation. You may have some cramping pains or discomfort, similar to period pains. You will also have some vaginal bleeding and discharge, which may last for up to three to four weeks.
Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).
Complications specific to endometrial ablation are rare but can include:
Endometrial ablation doesn't work successfully for everyone and you may need to have the operation again or choose an alternative treatment.
The amount of blood lost during a period is different for every woman. However, you may have heavy periods if you need to change your sanitary towel or tampon every one to two hours, if you have flooding or pass lots of heavy clots, or if your periods usually last longer than seven days.
During your period, bleeding usually lasts about three to five days, with the bleeding heaviest during the first two days. Sometimes a period can last up to eight days.
The amount of blood you lose during your period is usually only enough to fill about eight teaspoons or about 40 millilitres (ml). Doctors say that a heavy blood loss is 80ml or more, but in practice it's hard to measure the amount of blood you're losing. Instead, your periods are said to be heavy if they interfere with the quality of your day-to-day life and if you bleed heavily during every period.
If you have to change your tampon or sanitary towel every one to two hours, or if your period lasts for longer than seven days over several cycles, these are also signs of a heavy period.
Heavy periods can affect many aspects of your life and increase your risk of having anaemia (a condition where you don't have enough red blood cells to transport the oxygen around your body), making you feel tired and breathless.
If you think you have heavy periods, see your GP for advice.
It's possible that your heavy periods may come back after having endometrial ablation. You may be able to have the treatment again or your surgeon may suggest a different treatment – for example, a hysterectomy.
Endometrial ablation works by destroying the lining of your womb, the endometrium. This means your womb lining can't thicken during your menstrual cycle and so you have light periods or sometimes your periods may stop altogether. However, this treatment doesn't work for everyone and you may find that after your operation, your periods stay the same or are lighter to begin with but get heavier and longer as time goes on.
There are several different methods used to remove your womb lining, such as heated water, laser, an electric current, microwaves or radio waves. So, your surgeon may suggest having endometrial ablation again using a different method or repeating the procedure as before.
Having a hysterectomy is the only definite cure for heavy periods, but it has a higher risk of complications than endometrial ablation.
Endometrial ablation isn’t suitable for everyone. If you want to have children, you won't be offered this kind of surgery. If you have a small womb or large fibroids, or if you have had hormone treatments, multiple caesarean sections, severe endometriosis or a previous infection in your pelvis, you may not be able to have endometrial ablation.
Around three quarters of women who have endometrial ablation for heavy periods find that their symptoms improve and their periods become lighter. Around half have no periods at all after this kind of surgery.
Endometrial ablation is likely to be recommended if:
However, there are some conditions and circumstances when this kind of surgery may not be suitable for you. You may not be recommended endometrial ablation if:
If you're using an intrauterine system for contraception, or have a contraceptive ring or diaphragm inserted, you must have them removed before you have your operation.