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Endometrial ablation

The Australian Centre for Female Pelvic and Vaginal Rejuvenation
The Australian Centre for Female Pelvic and Vaginal Rejuvenation

What is an endometrial ablation?

An endometrial ablation is a surgical procedure aimed at destroying or removing the endometrium (the lining of the uterus)

Indications for endometrial ablation

Heavy &/or prolonged abnormal bleeding in the absence of endometrial pathology.

Alternatives to endometrial ablation

Endometrial ablation is one of a number of treatments to control heavy/prolonged uterine bleeding. Other treatments include:

  • Management of any underlying condition such as thyroid dysfunction.
  • Anti-inflammatory drugs.
  • Drugs that affect the clotting system.
  • Combined oral contraceptive drugs.
  • Progesterone only drugs.
  • Progesterone implants (Mirena/Implanon).
  • Hysterectomy.
Investigations prior to endometrial ablation

Should be preceded by:

  • History
  • Clinical examination

Depending on your particular circumstances may include:

  • Blood tests.
  • Endometrial tissue biopsy.
  • Hysteroscopy.
  • Ultrasound imaging.

Endometrial ablation techniques

Endometrial ablation techniques have evolved and increased in number over the years. They now involve quite different modalities of treatment. they can be divided into first generation endometrial ablation treatments (FEAT) or second generation endometrial ablation treatments (SEAT). All of the techniques involve the delivery of an energy source to the endometrial layer of the uterus.

First generation modalities

Electrocautery

An operating hysteroscope is used and the procedure done under endoscopic vision. An instrument with either a wire loop or rollerball has electricity passed through it on activation and on contact with the endometrial lining, destroys the lining.

Second generation modalities

Cryoablation

A probe is passed through the cervix into the uterus. The probe is then super-cooled and used to freeze and thus destroy the endometrial lining of the uterus. The procedure is facilitated by u/s guidance via the abdominal wall.

Hydrothermal

A probe is passed into the uterus and heated fluid passed out through it directly onto the endometrium which is destroyed by thermal injury.

Balloon

A balloon device is passed into the uterus. The balloon is filled with fluid which is heated to a designated temperature. The destruction of the endometrium is thermally mediated but is affected by the pressure of the balloon in the uterus.

Microwave

Microwave energy is delivered to the endometrium through a specialised probe inserted into the uterus via the cervix.

Radiofrequency

A probe with a collapsing fan shaped end is placed in the uterus, opened and then an electrical current passed through the triangular mesh, thus destroying the endometrial lining. Suction is used to evacuate fluid, debris and gases.

Guide to Balloon Endometrial Ablation Systems

A small soft, flexible balloon attached to a thin tube is first passed through the vagina and cervix, and then placed gently into the uterus. No incision is required. The balloon is made of silicone material, eliminating the risk of allergy for latex-sensitive women.

The balloon is then inflated by filling it with a dextrose-saline solution. The balloon, under pressure becomes applied to the contours of the endometrial lining.

The fluid is heated through a computerised system to a specified temperature. The fluid circulates within the balloon for a specified treatment time.

When the treatment is completed, all the fluid is withdrawn from the balloon, and the catheter is removed. Nothing remains in the uterus. Once the balloon has been removed from the uterus, it is refilled with fluid to check for integrity.

The treated uterine lining will shed, like during a period, over the next 7-10 days.

Principles of the procedure
  • Performed under general or regional anaesthesia in an accredited hospital.
  • It is a day case procedure.
  • Usual sterile techniques employed for surgery are used.
  • Endometrial ablation may be preceded by hysteroscopy & endometrial biopsy.
  • Intravenous antibiotics are administered during surgery.
Risks specific to endometrial ablation
  • Procedure not performed due to cervical or uterine abnormality.
  • Uterine perforation (rarely requires laparotomy).
  • Pelvic infection.
  • Fluid overload (with electrocautery techniques).
  • Thermal damage to abdominal organs.
Notify your doctor if you experience:
  • A fever or are feeling unwell.
  • Offensive vaginal discharge or heavy bleeding.
  • Nausea and vomiting which does not settle.
  • Unable to empty your bladder or bowel.
  • Severe pain.
  • Difficulty urinating.
After surgery:
  • Crampy lower abdominal pain is common and can last up to 7 days.
  • Vaginal blood loss will occur but should not be excessive.
  • Use painkillers as required.
  • Avoid strenuous activity for at least 7 days.
  • Refrain from sexual intercourse for at least 2 weeks.
  • Watery blood-stained discharge can continue for 4 weeks.
Outcome of endometrial ablation:
  • Amenorrhoea in up to 20% of patients.
  • Reduced bleeding in up to 70%
  • No change in amount of bleeding in 10%.
  • Blood loss may decrease over the months after endometrial ablation.
  • Blood loss may begin to increase again months after endometrial ablation.
Laser Vaginal Rejuvenation Institute of Adelaide
Laser Vaginal Rejuvenation Institute of Adelaide