Endometrial Ablation

What is an endometrial ablation?

It is now possible to see inside the womb (hysteroscopy) to investigate women having heavy periods and carry out treatment at the same time (endometrial ablation). The lining of the womb is removed either under direct vision, using diathermy (TCRE, endometrial resection) or with newer second-generation techniques such as Novasure or Microwave ablation (MEA). This procedure is an alternative for women who previously would have been offered a hysterectomy (a major operation removing the womb) and is not suitable for women still planning a family. Using no cuts, a small telescope is inserted into the cavity of the womb through the vaginal route. It has a small video camera attached that allows the enlarged picture from the telescope to be seen on a television screen. The procedure can be performed under a local or general anaesthetic, usually as a day case or outpatient procedure. Treatment results are excellent with women noticing a dramatic difference in their periods within a month or so after the procedure.

Why am I having a hysteroscopy and endometrial ablation?

You may be having heavy periods, not settling with usual medications or with irregular bleeding. This needs investigation, especially if you are above the age of 40, usually with an ultrasound scan and blood tests first, followed by a hysteroscopy. Usually a hysteroscopy is performed first (a telescopic examination that allows the lining of the womb to be inspected), to identifying anything that might be causing your problem (e.g. a polyp or fibroid). A sample or a biopsy (removing of a few cells from the lining of the womb) is usually taken to allow further analysis by a pathologist. Treatment can then usually be carried out at the same time. Polyps (localised thickening of the lining of the womb) or small submucous fibroids (benign growths within the lining of the uterus) can be treated at the same time as having the lining removed (endometrial ablation). You will still need to use effective contraception after the procedure. This will be discussed in detail at the consultation. Some women choose to have a Mirena coil fitted at the same time.

Can I become pregnant if I wish after the operation?


Will I need to use contraception after the operation?


How long will I stay in hospital?

You will usually be discharged home in a few hours after your operation or the following morning, dependent on how you feel.

Do I need to fast before the operation?


  • Morning Operation: No food or chewing gum after midnight before your procedure. You can drink water up to 6 am of the morning of your procedure. Please take your essential medications as normal with a sip of water, unless advised by nurse or doctor.

Do I need to stop my medications before my procedure?

You normally should not stop any of your essential medications. Please take your usual essential medications with a tiny sip of water at the regular time. Do remember to bring a list of all your medications to show the nurse at your pre-assessment (if you are having one) and also let your admitting nurse and anaesthetist know all the medications you are on. This is because your medications may influence your anaesthetic and surgery. You should also inform the nurse and anaesthetist of any allergies that you have to foods, metals, drugs etc. Some important notes on certain conditions are listed below.

DIABETES (insulin or tablet)


ASPIRIN, WARFARIN, CLOPIDOGREL, CLEXANE or any blood thinning agent

You will need to stop most blood thinning agents such as Aspirin or Clopidogrel at least 1-2 weeks before your procedure. This is to avoid excessive bleeding at your operation. If you are on Warfarin or Clexane, you will need to liaise with your surgeon and cardiologist. If in any doubt, consult your surgeon or anaesthetist and certainly inform them when you see them, as it may influence your management.

What can I expect after a Hysteroscopy?

  • Vaginal bleeding: Some amount of vaginal bleeding and discharge is to be expected, usually for 6-8 weeks. As long as this is not heavy, or has an offensive smell or causes you concern, this is normal.
  • Avoid tampons, usually for 2 weeks after the procedure, to reduce risk of infection.
  • Pain: Some women may experience slight lower abdominal discomfort. You can take your usual painkillers (such as Paracetamol or Ibuprofen) if you think it necessary.
  • Returning to work: You will be able to go to work the next day or as soon as you feel able. Other issues You will be able to resume sexual intercourse when you feel comfortable. You may wish to wait for a week or so once the bleeding has eased.

Are there any risks with the procedure?

Endometrial ablation is a safe procedure, but like any other operation, comes with some small risks. There may be a risk of infection, heavy bleeding or perforation (damage to womb) but these risks are uncommon and usually occur in less than one in a hundred cases.

When will I know the results of the procedure?


Nitu Bajekal (Consultant Gynaecologist, Feb 2009)