Introduction
Menorrhagia is defined as unusually heavy and or long-lasting menstrual periods. 1 in 20 women suffer from menorrhagia which can be disruptive to your family, social life, work life, regular daily activities and even your mood. Over the past decade, an alternative procedure called Endometrial Ablation has been used successfully in the UK to avoid unnecessary hysterectomies.
Endometrial ablation is a safe technique that thins or destroys the lining inside of the womb (endometrium). Your periods may become normal, lighter or may stop altogether.
Endometrial ablation is routinely done as a day case procedure under a general anaesthetic, this means you will have the procedure and go home the same day. You will be asked to follow fasting instructions which will be provided.
This procedure is not recommended if you wish to conceive in the future.
What happens during Endometrial Ablation?
The exact type of endometrial ablation you have will depend on your personal circumstances. Special instruments are used to destroy or remove the womb lining using
Heated fluid – A deflated balloon is placed inside your womb and filled with a heated fluid (Thermachoice endometrial ablation)
Radio waves – A probe is placed inside your womb which uses radio waves (Novasure Endometrial Ablation)
Mr Chattopadhyay will decide on either Thermachoice or Novasure ablation and will discuss this with you prior to the procedure.
What will I feel after the procedure?
Following 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 and will also be given painkillers. Precise instructions will be provided with the tablets. 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 where you should take it easy for the rest of the day. 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. You may feel moderate cramping like period-like pains.
What can I expect after I go home?
Most women can return to work and family commitments by the next day. Over the following 2-4 days sexual intercourse should be avoided. After the procedure there may be vaginal blood loss like a period for the next 7-10 days. Try to use sanitary towels rather than tampons at this time to help lower the risk of infection. This is usually followed by a watery bloody discharge for up to four weeks as most of the lining of the womb is replaced by inactive tissue.
What are the risks following the procedure?
The procedure may pose some rare, but possible, safety risks including blood loss, heat burn of internal organs, electrical burn, perforation (hole) or rupture of the wall of the uterus, or leakage of heated fluid from the balloon into the cervix or vagina. There may also be a risk of infection, usually, easily managed with oral antibiotic therapy. You should call your GP if you develop a fever, worsening pelvic pain that is not relieved by oral painkillers, nausea, vomiting, bowel and bladder problems and / or greenish vaginal discharge.
Success Rates
The overall success rate of this operation is about 80%. This means that in about 30% of cases, periods stop completely. In others (30 – 40%) they continue but are much lighter than before.
A small number of women may have one or two heavy periods after the operation before settling down to a lighter pattern. It takes between 6-12 months to be certain of the effects of endometrial ablation.
The effect is believed to be permanent, but there is a small possibility that the lining of the womb may re-grow to its former condition. If this happens, a repeat operation may be a suitable remedy but should it ever prove advisable, the opportunity to have a hysterectomy still remains.
Can I get pregnant following the procedure?
This therapy should not be used if you ever want to have children; in fact, pregnancies after ablation can be dangerous for both baby and mother.
Since there is a chance that pregnancy can occur, contraception or sterilisation should be used following the procedure.
Smears
Cervical smear tests are still necessary after operation, as the cervix is not removed.
Hormone replacement therapy (HRT)
If you are having HRT before or after endometrial ablation, you should ensure that it still contains a progestogen component, so that you take a combined form of HRT.
