Endometrial ablation for heavy periods: who it suits, risks and recovery

Heavy periods can mean flooding, clots, anaemia and cancelled plans. NHS information describes tablets such as tranexamic acid, hormonal options including a coil that releases hormone, and the combined pill as the usual first treatments. Ablation is for people for whom those have failed, are unsuitable or are not wanted, and who are certain they do not want to carry a pregnancy in future.

The womb lining is normally examined first. One trust requires a hysteroscopy and lining biopsy that was normal within the last six months. Ablation is not appropriate if that check shows an abnormal lining, and it is a poor choice if heavy bleeding comes from fibroids that distort the cavity or from something that needs separate treatment. Hysterectomy and fibroid treatments are the alternatives the NHS lists alongside it.

Contraception remains necessary after ablation. Leaflets stress that although pregnancy can still occur, it is dangerous, with higher chances of miscarriage and of the pregnancy implanting outside the womb.

A pregnancy test is done before the procedure, and one leaflet advises using contraception from the start of the period before treatment. Timing within the cycle is set by the unit, because the lining is thinner after a period or after hormonal pretreatment.

The preparation depends on the anaesthetic. For local anaesthetic you are usually asked to eat lightly and take painkillers as instructed; for general anaesthetic you follow standard fasting rules. Wear loose clothing and bring sanitary pads rather than tampons.

• Take any painkiller advice in your appointment letter literally; timing matters.

• Tell the team about blood thinners and any previous caesarean or womb surgery.

• Bring someone to accompany you if you are having a sedative or general anaesthetic.

The leaflets describe three routes. Under local anaesthetic, a speculum is placed, the cervix is numbed by injection, and a thin camera checks the cavity. Entonox, known as gas and air, may be offered. The alternative is a general anaesthetic as a day case, which suits people who prefer to be asleep or who cannot tolerate the cramping.

The device is passed through the cervix and expands to fit the cavity. One leaflet describes high-frequency radio waves heating the lining; the Leeds leaflet describes heat that removes or thins it. The treatment phase takes no more than two minutes, with five to ten minutes of set-up, and a trust gives the whole appointment as about 45 minutes including discussion. Cramping is common while the device works.

Leaflets list infection, bleeding, injury to the wall of the womb and adhesions as possible complications. Because the aim is lighter, not absent, periods, outcomes vary: one trust quotes 1 in 5 people with continuing bleeding and 1 in 6 needing a hysterectomy within two years, and another describes late failure of ablation in 1 in 4 cases over five years. These are different measures, so take them as a general picture of how often ablation does not last.

A less obvious concern is that the lining can hide later problems. Bleeding after the menopause or bleeding that changes after ablation should always be reported, because examination of the womb is harder to do afterwards.

After local anaesthetic most people are home within the hour. Period-type cramps are common, and one leaflet recommends ibuprofen and paracetamol for the first 48 hours if you can take them. A watery or bloody discharge can last up to two weeks in the Leeds leaflet, and the Morecambe Bay leaflet describes slight bleeding for six to eight weeks.

Return to work is described as two to five days. Avoid tampons and sex until discharge has stopped. After a general anaesthetic do not drive for at least 24 hours, and GOV.UK advises asking your doctor if you are unsure when to restart.

• A high temperature or a smelly discharge: contact your GP, the unit or NHS 111.

• Burning when passing urine, or lower tummy pain that is not settling.

• Heavy bleeding, soaking pads quickly, or passing large clots.

• Collapse, severe one-sided pain or fainting: call 999, because a pregnancy outside the womb must be excluded.

• Have my fibroids or polyps been ruled in or out?

• Is local anaesthetic realistic for me, or should I be asleep?

• What happens if my periods are still heavy afterwards?

• Which contraception do you suggest in future?

The devices and the techniques are broadly the same. Outpatient ablation under local anaesthetic is widely offered on the NHS, though availability differs by area. In private care appointments tend to be easier to arrange and a general anaesthetic may be simpler to book; ask what a repeat procedure or later hysterectomy would cost or involve before you start.