Endometrial Ablation – Oren Zarif

Endometrial ablation helps women who have heavy, long periods or bleeding between periods. This is called abnormal uterine bleeding (menorrhagia).

You may need to stop taking medicine that makes it hard for your blood to clot before your procedure. Ask your healthcare provider about this. You will need to arrange for someone to drive you home after the procedure because of the anesthesia and pain medicines.

Preparation

During an endometrial ablation, your doctor removes the tissue that lines the inside of your uterus. This removes the need for your body to make new lining each month. This may reduce or stop heavy menstrual bleeding. It can also help control symptoms of uterine fibroids and other growths in the womb.

Your doctor will talk to you about the procedure before you have it done. They will explain what will happen and why. They will ask you to sign a consent form.

You can have the procedure at any time, but it is best if you do it just after your period ends. This is when the womb lining is thinnest. Your doctor might also take a sample of the womb lining for testing (biopsy) before you have the operation.

The procedure can be done at a hospital or in your doctor’s office. It usually takes less than an hour. You will need someone to drive you home afterward, as the medicine used during the procedure can make you sleepy.

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Before the procedure begins, you will need to undress completely and put on a hospital gown. Your doctor will then start an intravenous line in your arm or hand. The line will give them fluids and medicines throughout the procedure. You will also have a tube in your hand to drain blood or other fluids.

Some doctors use ultrasound to guide the hysteroscope or other tool to the areas they are treating. Some ablation techniques use a wire that passes electricity through the hysteroscope to heat and destroy the tissue. Other methods use a metal mesh that expands and is heated by high-energy radio waves.

The type of ablation your doctor uses depends on the cause of your heavy menstrual bleeding. This might include changing hormones, a change in how your uterus is shaped, or abnormal tissue such as polyps or fibroids. Your doctor might suggest this treatment if medicine or an intrauterine device doesn’t work.

After the procedure, you can return to your normal activities in a day or two. You might feel some stomach cramping. Your doctor might prescribe pain relief medicine for you to take at home. You can also take over-the-counter painkillers like paracetamol or ibuprofen. Follow your doctor’s instructions about when you can exercise, have sex and use tampons. It is unlikely you will get pregnant after this procedure, but you should continue to use birth control until you have finished having children. You might need to have routine Pap tests and pelvic exams after the surgery.

Procedure

During this procedure, the thin layer of tissue that lines your uterus (endometrium) is destroyed. This usually stops or reduces heavy menstrual bleeding in women who have finished having children and are over the age of 45. It's also an option for women who have had a hysterectomy or who have severe abnormal vaginal bleeding that doesn't respond to medications. You can have endometrial ablation in your doctor's office or as part of a hospital stay. You'll be asleep during the procedure under local or general anesthesia, depending on your condition and which type of ablation you have.

You may be asked not to eat or drink anything for six hours before your surgery. Your doctor or anaesthetist will give you instructions on this. You'll need to arrange for someone to drive you home after your procedure, if needed. You'll probably be given pain-relief medicine before you leave the hospital. If not, your doctor can recommend over-the-counter medicines such as paracetamol or ibuprofen. Always read the patient information that comes with your medication and follow your doctor or nurse's advice on how much to take.

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Your doctor will use a lighted viewing device called a hysteroscope to see inside your body, including the cervix and the uterus. They'll insert the hysteroscope into your uterus through the vaginal opening. Then a tool with a wire loop or roller ball with electrical current or heated fluid will be put into your uterus and used to destroy the lining.

Another option is for a heated balloon (balloon therapy) to be inserted into your uterus through a tube. Heated fluid is then pumped into the balloon, and it expands to touch the lining of your uterus. The heat from the balloon destroys the lining. The process takes about 10 minutes.

A third option is for your healthcare team to pass high-energy radio waves through a mesh electrode inserted into your uterus. This method also destroys the lining of your womb, but it's less common because it can damage nearby organs.

Before the procedure, you'll be given an ultrasound test to check your ovaries and uterus for signs of cysts or fibroids. Your doctor may also ask for a sample of your uterine lining to test for cancer cells or other problems.

Your doctor will explain what the procedure involves and ask you to sign a consent form. Make sure you understand all of the risks and benefits of the procedure. You'll be given a time for the procedure to start. The test usually takes about half an hour. You'll need to lie on your back during the test. You might feel some pressure on your abdomen, but this won't last long. After the procedure, you'll need to wait until any bleeding or spotting has stopped before having sex and using contraception.