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Heavy periods (menorrhagia)

This is common. It is difficult to measure blood loss accurately. Periods are considered heavy if they cause such things as: flooding, the need for double sanitary protection, soaking of bedclothes, passing clots, or if your normal lifestyle is restricted because of heavy bleeding. See your doctor if your periods change and become heavier than previously. There are various causes of heavy periods. However, in most women, the cause is unclear and there is no abnormality of the uterus or hormones. Treatment can reduce heavy periods, and is dealt with in more detail in another page called 'Heavy Periods'.

Endometrial ablation is a treatment for heavy bleeding.

Endometrial ablation is the removal or destruction of the endometrium (lining of the uterus or womb).  Ablation is an alternative to hysterectomy for many women with heavy uterine bleeding who are wish to avoid major surgery.  After a successful endometrial ablation, most women will have little or no menstrual bleeding.  Patient selection and doctor experience is essential to a good outcome. Make sure your consultant is both trained in this procedure and regularly performs it on the NHS.

Who should consider endometrial ablation?

Women who have menstrual bleeding that is impacting their life, and do not have other problems that require a hysterectomy should consider Endometrial ablation
  • You limit your activity because of your periods
  • Bleeding is causing you to be anemic and tired
  • Bleeding limits your intimate time with your partner
  • You do not desire to retain fertility

Who shouldn't have an endometrial ablation?

Since an endometrial ablation destroys the lining of the uterus, endometrial ablation is not for anyone who desires to keep her fertility.  Women who have a cancer or pre-cancerous condition of the uterus are not candidates for ablation.  Women who have severe pelvic pain, unless the pain is coming from a fibroid within the womb, may be better served by alternative treatments.  Although pregnancy is unlikely after ablation, serious complications could arise.  It is essential for to use reliable contraception after an Endometrial ablation

What are the alternatives?

Endometrial ablation may be recommended if non-surgical treatments, such as taking medicines (such as the combined oral contraceptive pill) or an intra-uterine system (a coil in the womb - Mirena®) don't help reduce heavy bleeding or you decline these treatments after careful consideration. Endometrial ablation is not usually recommended if you have growths in your womb (fibroids) or if you want to have children in the future, because it affects fertility.

A good gynaecologist will discuss the pros and cons of all options and explain which are the best for your particular circumstances.

What is a "balloon ablation?"   What about other devices?

Thermachoice™ balloon uses a balloon placed in the uterine cavity through the cervix.  Hot water is circulated inside the balloon to destroy the lining of the womb. It is very safe with the machine either not activating or switching off if there is a risk that the temperature is getting too high or there is a hole in the womb. The treatment fails 15% of the time but the other 85% have lighter or no periods.

Another new device, the Novasure System™, is now available.

Risks of endometrial ablation

As with any surgical procedure, there are risks, which should be compared to the risks of things we do in everyday life.  A number of things can be done to reduce these risks.  Some of the risks of endometrial ablation procedures are perforation of the uterus, bleeding, and infection. Abnormal bleeding should be evaluated whether or not you have had an ablation.

A small percentage of properly selected women having an ablation will still eventually need a hysterectomy, but the vast majority will not.  Having done endometrial ablation since 2000, I can usually identify women who will have a successful ablation and those who would be better off with other treatment.

Who can help me decide if an endometrial ablation is for me?

It is helpful to see a gynecologist who is familiar with, and who is able to provide all of the alternatives for the treatment of your problem.  A doctor who does not do endometrial ablation on a regular basis is unlikely to have the experience to help you make the best decision.  The gynaecologist should consider non-surgical treatments, as well as discussing the advantages and disadvantages of all the options available.  While the gynaecologist can provide you with information, the decision is ultimately yours.

What does the procedure involve?

Endometrial ablation usually takes about half an hour. A telescope called a hysteroscope is passed through the vagina and cervix so that the surgeon can see your womb. Special instruments are then used to remove the womb lining as a biopsy as it is essential to rule out cancer. A balloon-like device is then tested, placed in the womb and filled with fluid. The fluid is heated to destroy the womb lining and it stays there for 8 minutes. The balloon is then emptied and removed once the fluid has cooled down.

What to expect afterwards?

If you have a general anaesthetic, 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 the same day 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. You should try to have a friend or relative stay with you for the first 24 hours.

Recovery from endometrial ablation

Most women are able to go home within a few hours after the Endometrial ablation  There may be mild cramping, which can usually be relieved by ibuprofen and/or paracetamol.  Occasionally stronger medicine may be needed.  The anaesthetist will prescribe regular pain relief medication – take this even if you do not have pain to prevent the pain from developing. It is normal to be tired for a few days, but most women are able to return to most normal activities in 3- 5 days.  Intercourse and very strenuous activity is usually restricted for 2 weeks.  It is normal to have an increased discharge for 2 to 4 weeks afterward, as the lining is shedding. 

You shouldn't use tampons for at least one month after having an endometrial ablation to help lower your risk of infection. If you develop any of the following symptoms contact your GP or Consultant as you may have developed an infection:
  • prolonged heavy bleeding
  • vaginal discharge that is dark or smells unpleasant
  • severe pain
  • pain that lasts for more than 48 hours
  • high temperature

It can take up to three to six months to see whether the operation has been successful. Most women have lighter periods after the procedure, others will stop having periods altogether. Contact your GP or surgeon if you start to have heavy periods again.

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