Endometrial Ablation
Dr G.D. Reid & Dr H.F. Joyce
Endometrial ablation or resection is a method of controlling menorrhagia (heavy periods) by destruction of the endometrium (lining of the uterus). It is performed by cauterising or removing the endometrium, leaving only myometrium (muscle) and fibrous tissue. When the endometrium sheds at the time of menstruation, a thin basal layer is left from which the endometrium regenerates during the next cycle. The aim of endometrial ablation is to remove this basal layer so that no regeneration occurs.
Suitability for Endometrial Ablation
It is an alternative to hysterectomy in many women with heavy periods, and is also of value in post-menopausal women who bleed heavily with hormone replacement therapy.
It is not suitable for patients who:
- Have a very large uterus
- Have a uterus which contains large or multiple fibroids (benign growths arising from the uterine wall)
- Suffer marked pain with periods
- Wish to become pregnant at some time in the future
- Have cancerous or pre-cancerous change within the uterus
The Procedure
Either a general anaesthetic or an epidural anaesthetic is used during the procedure, which therefore requires admission to hospital or a day surgery unit.
A telescope (hysteroscope) is passed into the cavity of the uterus through the cervix. A camera attached to the end of the hysteroscope transmits a high quality image to a video monitor giving the surgeon a direct view inside the uterus. A continuous flow of fluid under pressure is used to distend the cavity and to wash out any blood.
After inspection of the uterine cavity, the endometrium is removed using electrocautery through a cutting loop or a rolling ball electrode.
The procedure usually takes 30 to 60 minutes. Occasionally a laparoscopy is performed at the same time to check the outside surface of the uterus.
After the Procedure
Most patients leave hospital after approximately 4 hours but occasionally an overnight stay is recommended. Because an anaesthetic is required a friend should pick up the patient, as a car should not be driven for at least 24 hours.
There may be some cramps or mild pain for 2 to 3 days, requiring analgesics, but normal activities can be resumed by the 3rd or 4th day.
There may be watery, initially blood-stained discharge for 2 to 3 weeks, although occasionally this may last up to 4 to 6 weeks. Sexual intercourse should be avoided for about 2 weeks or until bleeding has stopped.
Results of the Procedure
Approximately 85% of patients will be satisfied with the outcome of their surgery. These are women whose periods stop or become significantly lighter. About 15% of women find that their menstrual loss becomes heavy once again, and most of these would have the procedure repeated or decide to have a hysterectomy.
Other Aspects
After Endometrial Ablation the uterus and cervix are still present so regular Pap smears should be continued.
The ovaries also remain and are not affected by this treatment. Hormonal production from the ovaries continues until the normal onset of menopause. Women taking hormone replacement after endometrial ablation should take both oestrogen and progesterone.
It should not be assumed that endometrial ablation will prevent pregnancy. While pregnancy is unlikely to occur, contraception should be considered as a separate issue. There is some evidence that pregnancies occurring after endometrial ablation have a high incidence of complication.
Risks of the Procedure
Complications are rare, especially when compared with other operations such as hysterectomy.
The following complications have been reported:
- Perforation of the uterus and damage to other organs, including the bowel and blood vessels. This complication would require an immediate open operation (laparotomy) to repair the damage.
- Excessive bleeding requiring transfusion or even hysterectomy.
- Excessive absorption of fluid during the procedure causing severe problems with blood chemistry.
- Infection which is rare and generally readily treated.
Conclusion
Endometrial ablation offers a high rate of cure for heavy periods without having to remove the uterus. The short hospital stay and rapid convalescence makes this an attractive alternative to hysterectomy if this procedure is suited to the patient
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Last updated 24th November, 1998