endometrial ablation
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  • Fertility | Gynaecology
  • 07.09.22

Endometrial ablation – A chat with Dr Tina Fleming

If you have extremely heavy or long periods, or bleeding between periods, your gynaecologist may have discussed endometrial ablation. While it’s a common procedure, many women don’t know what it involves. 

We had a chat with Dr Tina Fleming, Grace Private Gynaecologist, Obstetrician and Fertility Specialist to learn more about endometrial ablation.

About the endometrium

 To completely understand how endometrial ablation works, it helps to understand the endometrium. 

 The endometrium is the layer of tissue that lines the uterus. Every month the endometrium sheds. It’s made up of two parts, a superficial part called the superficialis and a deeper part called the basalis. The superficialis is created when the cells thicken. If pregnancy doesn’t occur, menstruation occurs when you shed the superficialis layer, leaving the basalis layer underneath. 

What is endometrial ablation and why would you have one? 

During an endometrial ablation, the lining of the uterus (endometrium) is obliterated using heat energy.  Because the heat also obliterates the basalis layer of the endometrium, the lining cannot grow back each month.  This is different from a curettage procedure where only the superficial layer is removed and thus can regenerate afterwards. 

 This procedure may be recommended by your gynaecologist if you have a history of heavy or long periods that affect your daily activities. Other alternatives for treating these conditions include anti-inflammatory tablets, the contraceptive pill, Mirena IUD insertion, and hysterectomy. 

endometrial ablation

What does the procedure involve? 

How the procedure is performed will depend on the individual, but it is usually performed under general anaesthetic and can take up to 30 minutes. 

Firstly, your gynaecologist will examine your vagina, before inserting a thin telescope like device called a hysteroscope or resectoscope across your cervix into your womb. They will then pass fluid through the scope to swell your womb before using  electrical heat energy to obliterate the lining of your uterus. 

Is it effective? 

Endometrial ablation is highly effective.  It results in reduced bleeding, or absent bleeding for 95% of patients.

Is an endometrial ablation painful? 

 If you have general anaesthetic you shouldn’t feel any pain or discomfort.  There can be some period-like cramping discomfort for 24-48 hours after the procedure, however most women find they can return to normal activities the day after the operation. 

Will you have periods after endometrial ablation? 

Generally, one third of women stop having their period after endometrial ablation, while others will continue to have light periods. 

Can you fall pregnant after endometrial ablation?

Endometrial ablation is not an option you should consider if you want to fall pregnant. For the majority of women, it’s not possible to fall pregnant after this procedure. Falling pregnant after an ablation can be dangerous for both you and your baby and as such we would always recommend to ensure a safe form of contraception (such as vasectomy, tubal ligation or Mirena) is used following the procedure.  

 What to expect after endometrial ablation? 

After an endometrial ablation, it’s normal to experience some discomfort or pain. You can take paracetamol, or other pain medication if required and recommended by your doctor. You may also experience some bleeding or blood-stained vaginal discharge for several days. It can take a few days to a couple of weeks to recover completely. 

Are there any risks associated with endometrial ablation? 

 Like any procedure, endometrial ablation does have risks, including: 

  • infection
  • allergic reaction to equipment or medication
  • blood clots
  • bleeding
  • fluid overload
  • a small hole in your womb from the instruments 
  • hematometra, where blood and other menstrual fluid collects in pockets in your womb
  • blood or fluid collecting in your fallopian tubes. 

Is endometrial ablation for everyone?

No. Endometrial ablation is just one of several treatment options available for heavy periods or abnormal uterine bleeding. You should talk to your GP or specialist and understand all the risks and consequences before you have this procedure. That said, if pregnancy is not a consideration and an endometrial ablation is an appropriate treatment for your individual condition, it can be a fast and effective option. 

If you’d like more information about pelvic pain, heavy bleeding or other gynaecological conditions, Dr Tina Fleming is available to help. For a referral, ask for ‘Grace’ next time you visit your GP. 

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  • Fertility, Gynaecology