Endometrial ablation is a medical procedure that is used to remove or destroy the lining of the uterus (endometrium).

Why ablation?

The lining of the uterus (endometrium) is shed by bleeding each month during a woman’s menstrual period. Sometimes the bleeding is too much or too long and treatment is needed. If bleeding does not respond to medication, your doctor may suggest endometrial ablation. This procedure treats the lining of the uterus to control or stop bleeding. It does not remove the uterus.

What are the alternatives?

Endometrial ablation is one of several options to manage heavy bleeding. Alternatives would include anti-inflammatory tablets, the oral contraceptive pill, Mirena intra-uterine system and hysterectomy.

How is an ablation performed?

Ablation destroys a thin layer of the lining of the uterus. This stops all menstrual flow in many women. After ablation, some women still have light bleeding or spotting. A few women may have regular periods. This is because the ovaries and uterus are not removed. If ablation does not control heavy bleeding, further treatment or surgery may be required.

Most women are not able to get pregnant after ablation. Thus, if you may want to become pregnant, you should not have endometrial ablation. Although pregnancy is not likely after ablation, you should take measures to avoid a pregnancy until after menopause. Falling pregnant following an ablation is often complicated with significant risk to the developing baby. Ablation does not affect sexual response. Your doctor may discuss the option of performing laparoscopic tubal sterilisation during the endometrial ablation.

The procedure is normally performed under a general anaesthetic in the operating theatre. While you are asleep, the cervix is widened (dilated) and a telescope is inserted to look at the internal aspect of the uterus. Your doctor will use one of a number of types of energy to burn away the uterine lining. These may include electrical or thermal (heat) ablation. This procedure does not involve any cuts or stitches to the abdomen. The procedure itself only takes approximately ten minutes, but you can expect to be in theatre and recovery for a number of hours.

What are the risks of undergoing this procedure?

Although the risks associated with ablation are minimal, you should be aware that every surgical procedure has some risk.

There are some specific risks to be aware of in relation to this operation:

• The procedure may not be able to be completed, due to narrowing of the interior of the cervix. Further surgery may then be necessary.
• It is possible to make a small hole in the uterus (uterine perforation). In most circumstances this is of no consequence. However, this may require a laparoscopy and/or laparotomy, resulting in a longer hospital stay than expected. In the event of uterine perforation, there is a risk of damage to adjacent organs, such as bowel or bladder, which may require further corrective surgery.
• In a very few cases, the fluid used to expand your uterus may be absorbed into your bloodstream. This may allow too much fluid in your body and can be serious, causing your hospital stay to be prolonged.
• Infection could be introduced into the uterus, tubes or abdominal cavity. This would require treatment with antibiotics.
• Excessive bleeding from the uterus can occur. This may require blood transfusion and further surgery.
• About one third of women will stop having their periods after an ablation. Most women will, however have lighter periods. Over time, the periods usually return and ablation is often not the best option for women who are many years away from menopause.

There are some general risks inherent to all operations:

• Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
• Clots in the legs with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be fatal.
• You may suffer a heart attack or stroke because of strain on the heart. Death is an extremely rare possibility for anyone undergoing an operation.

Some women, however, are at an increased risk of complications, including:

• Women who are very overweight have an increased risk of wound infection, chest infection, heart and lung complications and blood clots.
• Smokers have an increased risk of wound and chest infections, heart and lung complications and blood clots.

Preparation:

Preparation for your surgery

• It is important that you have all the tests, which your doctor has ordered, prior to coming to hospital.
• If you are taking any blood thinning or arthritis medications they may need to be stopped prior to surgery. Please check with your preadmission nurse or pharmacist.
• It is necessary that you have nothing to eat or drink (including water, lollies and chewing gum) at least six hours before your operation. You should stop eating and drinking at the following times on the day of your surgery:

• at 12 midnight for a morning procedure
• at 6 am for an afternoon procedure

• It is important for you to shower and dress into clean clothes prior to coming to the hospital. No skin products are to be used following your shower (e.g. deodorant, perfume, body lotion, powder)
• You need to bring with you:

• All X-rays, blood and ECG test results
• Any medications in their labelled containers or Webster pack.
• your Medicare Card
• your completed registration form
• underwear, sanitary pads, toiletries
• In some circumstances your surgery may need to be rescheduled or cancelled. If you are feeling unwell or have developed an illness we advise you to make an appointment with your GP who can then inform you if you are well enough to have surgery. If your surgery needs to be rescheduled or cancelled due to advice from a medical practitioner or due to unforseen personal circumstances please notify your gynaecologist as soon as possible.

After the procedure:

What should I expect after the procedure?

• You will stay in the recovery room within the theatre suite after the operation while you waken from the anaesthetic. You will then be transferred in your bed to the Day Procedure Unit.
• During your recovery your nurse will take frequent observations of your vital signs (e.g. temperature, pulse, blood pressure) for several hours after the surgery. As you become fully recovered, these become less frequent but remain regular until you leave hospital later the same day.
• You can expect to feel drowsy, have mild nausea and experience some lower abdominal discomfort.
• For pain control you will be given specific discharge medication if required, but you may use Paracetamol/Paracetamol-codeine as required (one to two tablets every four hours up to a maximum of eight tablets per day).
• It is also normal to expect a bloody vaginal discharge.
• Your nurse will discuss your follow-up appointment and any discharge arrangements that have been made with you.
• You should be eating and drinking normally, and be mobilising.

Discharge advice

• It is important that you stay in the company of a responsible adult within the Brisbane region for 24 hours and:

• do not drive or operate any heavy machinery
• do not consume alcohol for the remainder of the day
• do not drive a car, motorbike or ride a bicycle until you can comfortably operate foot pedals and/or change gears.
• do not sign any legal documents or make any important decisions
• do not engage in sports or heavy lifting

• It is common to have ongoing light bleeding and/or watery loss for several weeks
• You should be able to return to work the following day, but may require more time off work depending on the procedure performed
• Routine pap smear tests are still needed as all your reproductive organs are still in place
• It is important for you to shower rather than bath
• It is important for you to use sanitary pads and not tampons.