Endometrial ablation – Glengarry Private Hospital, Perth

Endometrial ablation – Summary

1. Endometrial ablation has been a popular option for controlling heavy periods for years.
2. Many women who have an endometrial ablation also reduce their period pain, but this is less consistent
3. Most endometrial ablations are done under a general anaesthetic.
4. Significant complications are uncommon.
5. Ablations are done as day case surgery at Glengarry Private Hospital in Perth.
6. The operation is usually well tolerated by most women.
7. Usually, a few days at home are needed to recover from the operation.
8. Your family must be complete. Contraception will still be needed.
9. The Novasure device delivers the best result for most women – we generally use this method.
10. Overall, endometrial ablation is an effective option for women in their forties with heavy periods who have completed their family.

Any surgical or invasive procedure carries risks. Before proceeding, you should do your own research and seek a second opinion from a qualified health practitioner. For instance, your GP.

Glengarry Private Hospital is a friendly hospital in the Northern suburbs in Duncraig, very near to the freeway, midway between Joondalup and Osborne Park Hospital.

Call us to arrange a consultation • Perth (08) 6119 9160

Endometrial ablation – what is it?

Endometrial ablation is a usually well-tolerated procedure to help heavy periods. Most of the women who have this operation will considerably reduce their periods. About half the time, the periods completely stop. We have been performing this procedure at Glengarry Private Hospital, Perth for many years. The endometrial ablation operation treats the periods by using energy. The energy penetrates below the “generation’ or basal layer of the lining of the womb that produces the new lining every month. It stops this layer from re-growing after the period, reducing or stopping further menstrual bleeding from the treated area. In the vast majority of cases, the period will be stopped completely or reduced to light flow/spotting only. Period pain is often reduced – about 80% of women see a big difference to pain. Around 5-10% of patients may not be satisfied after the ablation operation, and may require additional treatment, such as a further ablation or a laparoscopic hysterectomy.

What about hormones?

Endometrial ablation has no effect on the ovaries, so the hormones will be unchanged. Sometimes very local pelvic hormones (prostaglandins) that are released from the lining during the period that cause cramping & bloating & water retention are blocked from release. Therefore, endometrial ablation can quite often reduce these symptoms.

Who should have endometrial ablation?

Not all women who have heavy periods are suitable, and we will need to assess first. If you still want to have children, endometrial ablation is not an option since the uterine lining is removed during the treatment. Any pregnancy afterwards would not be sustainable & might be disastrous. If you have already had a sterilisation or your partner has had a vasectomy, an ablation can be an excellent choice for treating heavy periods. A sterilisation can also be done at the same time as the ablation – let us know if you would like this. Rarely, the womb can be simply too big for the ablation to work. Some abnormal uterine conditions (like submucous fibroids or some variations in the shape of the womb) may make ablation less effective unless they are dealt with at the same time as the ablation. If these issues exist, we can usually reshape the uterus at the same operation as the ablation to improve the end result.  If there are large fibroids, a hysterectomy is often a better choice. Some recent research shows that when significant fibroids are present, subtotal hysterectomy has overall better outcomes, but obviously the recovery is longer for any sort of hysterectomy. Overall, in Perth, endometrial ablation has been growing in popularity, as women realise they can stop or reduce annoying heavy periods with (usually) a fast recovery from the procedure.

There are several different types of endometrial ablation

1. Novasure endometrial ablation

Novasure is radio-frequency energy controlled endometrial ablation. It is the device illustrated in the picture at the top of this page. A fan-like device is inserted carefully into the womb after measuring it. The device has safety features so we can ensure the positioning is correct. The safety features also let us know if there is an inadvertent hole made in the uterus (whilst this is a rare complication, it is vital that this is known about before activating the energy). The device is then activated with a customised dose of energy. The RF energy removes the lining of the womb. It can get “into the corners” of the uterus better than the balloon types of ablation – as long as the womb is a normal size and shape. Overall, you’re more likely to completely abolish your periods with Novasure compared with balloon ablation. Over 50% of women will have no further periods, and most of the rest will have minimal bleeding. Period pain is also often helped. Novasure is good for regular-shaped wombs. If there is a septum or a submucous fibroid we can reshape them at the time of the ablation, and results after the ablation can still be excellent. Overall the Novasure method is the best method of ablation, and most of our endometrial ablations in Perth are done using technique.

2. Balloon endometrial ablation (Cavaterm)

Thermachoice III used to be one of the best balloon methods of ablation until it was withdrawn. Cavaterm is now the balloon method that some clinicians use. About 80% of women are satisfied/very satisfied with balloon ablation and many see their period pain reduce afterwards. We prefer the Novasure procedure for most women, however.

First, a soft balloon attached to a thin tube is inserted into the vagina, through the cervix and placed into the uterus. Then the balloon is expanded with a sterile fluid which expands to fill your uterus. The fluid in the balloon is heated & maintained while the uterine lining is treated and the endometrial ablation completed. When the treatment cycle is complete, all the fluid is withdrawn and the tube is removed. Nothing stays in your uterus. Your womb lining has been treated by the heat and there is loss like a period in the next few days. After this you can get a clear discharge for a few weeks. Cavaterm is quite good for large, irregular wombs.

3. Other types of endometrial ablation

The other types of ablation are performed using an operating hysteroscope. The lining is treated, or carved out (resected) and/or cauterised with electrical energy while fluid irrigates the womb and keeps the view clear. This is how we used to do endometrial ablation before the machine technology was perfected. These old “manual” methods take much longer, requires a lot more skill, are more expensive, and there are slightly more potential complications. The old methods are still used if the womb is very irregular inside, or we’re repeating the ablation to get a more comprehensive result. We probably use this technique monthly usually as an adjunct to Novasure to additionally treat missed areas. Re-do ablations also need to be done manually.

Can I try & get pregnant after endometrial ablation?

No. Endometrial ablation should never be used if you are undecided, or ever want to have children. Pregnancies after ablation are rare, and can be very dangerous for both baby and mother. Since there is a chance of pregnancy excellent contraception or, even better, male or female sterilisation should be in place before or after treatment. We will talk to you about this when you come to see us in our offices at Glengarry Private Hospital, Perth.

What will I feel after the endometrial ablation?

You will usually feel mild or moderate cramping like a period. We will give you simple painkillers to make you feel more comfortable. After a few hours in Glengarry Private Hospital here in Perth, you should be driven home where you can take it easy for the rest of the day. Occasionally there is no pain at all. Sometimes more severe pain caused by spasm can occur which needs stronger painkillers and an overnight stay. The majority of patients are feeling quite well when we catch up a couple of days after the operation.

What can I expect after I go home?

Most women can return to light work and family commitments a few days to a week after endometrial ablation. Sexual activity can be resumed when the discharge settles. Most patients have a pinkish and watery discharge for a few days or weeks, or even up to a month or so. In rare cases, the first period after the ablation is heavy, but this will begin to improve thereafter.

You should seek medical help if you develop a fever, pelvic pain not relieved by ibuprofen, vomiting, or a greenish discharge.

What are the risks with endometrial ablation?

The endometrial ablation is generally a safe procedure. The commonest risk is getting an infection afterwards which affects about one in ten women. This is usually managed with a course of antibiotics. There are some very rare, but possible, risks including blood loss, burn of internal organs, and perforation or rupture of the wall of the uterus. Collection of blood or tissue in the womb during the months afterwards is also possible and may require another procedure to correct the problem. All of these risks are very rare.

An important point

Sometimes when we look inside the womb, prior to doing the endometrial ablation, we find the lining looks abnormal. If we think this is cancerous, we may need to just take biopsy samples & not do the endometrial ablation on that day. If the samples come back as benign, we can then do the ablation at a later date. Also, sometimes we look inside the womb & it all looks fine and we take samples & do the ablation. Then we get the results a few days later & they show pre-cancerous cells. When this happens, we’ll then need to schedule a hysterectomy as the ablation is not enough to prevent the abnormal cells from possibly turning into cancer down the track. This happens very infrequently (eg. 1% of cases). There is little argument for always sampling first & waiting for results before doing an ablation – so we only do this if the lining looks abnormal.

Another important point

Sometimes, after a few years, the periods can return or increase. It is possible sometimes to go back in and perform another ablation. However, this has to be done manually in the “old-fashioned” way. Inside, the womb is often irregular & therefore needs a bespoke treatment with an operating hysteroscope. Call our rooms if this is an issue that affects you, as we can often offer a re-ablation.

Anything else?

Some women have a uterus that is shaped like a heart in side because of a uterine septum. Sometimes this needs to be removed to make the ablation more effective. This can be done at the same time as the endometrial ablation, and the recovery is unchanged. Other women have fibroids “in the way” and these can also be shaved off at the same time.

About us

We are accredited in all the standard methods: Novasure, Cavaterm and also have 20 years experience using the classic manual hysteroscopic ablation and hysteroscopic resection techniques. Please contact our clinic at Glengarry Private Hospital in Perth. You will need a referral from your GP.