- Endometrial Ablation is a procedure to destroy the lining of the womb by using energy source from electrical current, heat, laser or microwaves (see Table).
This stops menstrual bleeding.
- Suitable for very small fibroids of less than 4 cm which have grown in the thinner layer of the womb. Often, it is used in conjunction with other procedure such as hysteroscopic resection.
| Summary of types of endometrial ablation |
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Type of ablation
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Anaesthesia
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What is?
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Roller Ball Diathermy
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General
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This instrument has an electrically heated ball on one end which is rolled back and forth across the lining of the womb to destroy it.
Electric current also seals any bleeding areas.
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Balloon
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General or Local
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Simple and effective.
A special thin-walled plastic balloon is inserted into the womb and filled with warm water.
The water inside the balloon is heated. The temperature of the water and how long the balloon being left inside your womb is controlled electronically.
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Laser
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General
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This is done in the same way as diathermy technique above.
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Microwaves
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Local
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Does not use hysteroscope like the other three techniques above.
Uses microwaves to heat the inside of the womb to destroy its lining.
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As with any procedure, there are risks and potential complications associated with it (see Table below).
| Summary: risks/complications |
| Infection |
Managable with antibiotics. |
Adverse reactions |
Adverse reactions with anaesthetics. |
| Physical damage to the womb and other adjacent organs |
If un-repairable damage to the womb occurs, it may be necessary to perform an emergency hysterectomy.
The device used may perforate through the uterine wall damaging adjacent organs such as the bowel. |
| Absorption of fluid |
Rarely, but can be very serious when the fluid used to expand the womb gets into the body (applicable in laser or diathermy or electrical ablation).
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What happens BEFORE the procedure?
A few weeks before the procedure, your gynaecologist prescribes you medicine that thins the lining of the womb and reduces its blood supply.
It can be, for example, Danazol, oral drug or injectable hormone such as GnRH analogues (e.g. Zoladex).
As a routine, on the day, a pregnancy test is carried out.
What happens DURING the procedure?
- Most cases, the surgeon widens the cervix to allow him to pass the hysteroscope (connected to a TV monitor) to the womb for him/her to look inside.
- The surgeon places a special fluid to inflate the womb to get a clearer picture.
- When in place, energy is applied through the wand to destroy the lining.
- The burning process takes less than 4 mins for microwaves techniques and 10 - 15 mins for other techniques.
The total time of the whole process is 30 to 45 mins.
What happens AFTER the procedure?
- You can go home within a few hours.
- You may experience the followings:
- Cramps: can be resolved with medications.
- Light bleeding or watery vaginal discharge occurring within 1 week and for the first month.
- Do NOT use tampons. Use sanitary pads for at least in the first week.
- Do NOT have sexual intercourse for 1 week.
- Avoid strenuous activity in the first week.
- Contact the emergency department immediately if you develop heavy bleeding, abdominal pain or fever.
- Check up usually happens 3 months later.
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