A hysteroscopy is an investigation to examine the inside of the womb. It involves inserting a fine telescope into the vagina and passing it through the neck of the womb, to visualize the inside of the womb.

It allows the investigator to look for polyps or fibroids or abnormalities within the womb

Endometrial ablation/ resection for the treatment of heavy menstrual bleeding

The procedure involves destruction or removal of the lining  of the lining of the womb. It is a surgical method of treating abnormal heavy periods negating the need to have a hysterectomy.

In the olden days women used to have the so called D&C but this was found not to have any effect on the heaviness of bleeding.
to have effect it was found that removal of the "deeper" muscle layer of the womb was required. This has been shown to be effective in treating heavy menstrual bleeding.

The first endometrial ablation was performed in way back in 1948, however the modern technique was developed in 1981 with the first transcervical resection of endometrium was performed in 1983, where a loop was used to remove the lining of the womb. Subsequent to this Laser was used but instruments were too cumbersome and expensive.

Some of the problems with the technique were:

Difficulty in training doctors in the technique due to the amount of skill required performing the procedure safely.

Complications such as

• Perforation of the womb with damage to 
  

• Bladder and or
  

•  Bowel.
  

• Problems with absorption of fluid used to perform the procedure
  

• Bleeding requiring hysterectomy.
  

Though the studies that looked at the complications were in a way flawed, technology has been developed to lower the complexity of the procedure,

so it can be learned by more doctors, to theoretically reduce the risk of complications, making the procedure available to more women, and to allow the procedure to be performed under local anaesthesia in the day case setting.

Different types of procedures include:

• Balloon ablation (CavatermTM, ThearmachoiceTM)
  

• Novasure
  

• HydrothermalAblation, 
  

• Cryoablation, 
  

• Microwave ablation, 
  

• Radiofrequency,  
  

• VersapointTM. (bipolar)
  

• Photodynamic therapy.
  

all these technologies manage to treat heavy menstrual bleeding with varying techniques, and different levels of eff
On a whole the procedures are cost effective as the procedures are done as day cases and women are able to return to normal activities much quicker than they would if they had a hysterectomy.

On average 70-90% of women who have the procedure will have relief from symptoms of heavy bleeding.

Between 30-40% of women will stop having periods altogether

30% of women may need to have an additional procedure if the symptoms persist.

It is more successful in women over 45 years

Whatever type of ablation is performed CONTRACEPTION in still required as women have been known to fall pregnant after endometrial ablation and such pregnancies are usually plagued with difficulties with an increased risk of miscarriage

Small babies

Very adherent placentas

Educational Video of actual surgery. Showing Trancervical resection of endometrium for treating heavy periods

What to expect after an endometrial ablation

The destruction or removal of the lining of the womb is an effective alternative to hysterectomy for the treatment of heavy menstrual bleeding

Interestingly there was an article in the daily mail a few years ago calling these sort of procedures the “three minute hysterectomy”.

The “3 minute hysterectomy” it is NOT. Though it is a quick operation and some women will not have periods afterwards, the womb is still retained so without EFFECTIVE CONTRACEPTION, women can still become PREGNANT.

For some women the Mirena intrauterine contraceptive device may be a suitable option. If it is it can be inserted at the same time as the procedure.

There are various methods of destroying the lining of the womb. Some of these like the NOVASURE technique can be done in some centers under local anaesthetic.

All however are done as “day cases” where you go into hospital. Have the procedure and are discharged the same day.

For some women who have continuous bleeding your doctor may give you some medication to ensure that you are not bleeding on the day of the operation, this may be in tablet form for example PROVERA or injectable ZOLADEX. This is known as pre-treatment.

How long does it take?

For those procedures that are performed under general anaesthetic, they averagely take about 15-20minutes however “turn-around” time (meaning the time it takes to get into theatre, and be sent back to the ward from recovery) can take up to an hour.

Out of the recovery area

Once you come round from the anaesthetic, you would be offered something to eat and drink, and once your observations are satisfactory and you have emptied your bladder, and you are not bleeding heavily, your nurses will start preparing you for home.

Going home

You will not be able to drive home your self and you will need to be accompanied home by a friend or relative.

After an anaesthetic you should not operate heavy machinery for a day or two

Women are usually discharged with some painkillers as most describe a crampy abdominal pain similar to a bad period. This usually disappears within a day or so

There is usually some bleeding vaginally, which is no worse than a heavy period; sometimes this changes into a watery discharge for up to 10 days.

Sex

It is best to wait till the bleeding and discharge stop before resuming sexual intercourse

Women are advised to use Sanitary Towels rather than Tampons till the bleeding and discharge stops.

Back to work

You should be able to go back to work within a few days of the procedure.

Complications of the procedure include

Perforation of the womb, which can result in

Bowel or bladder injury

If these injuries occur it may be necessary for your doctor to perform a laparoscopy or laparotomy (open surgery) to inspect and repair the damaged organs

Bleeding

 Which can result in needing a hysterectomy as a life saving measure in about 1:500 women

Infection

The effects of this type of treatment are not immediate it can take up to 3 months if not longer to see whether the treatment has had the desired effect.
Follow up visit
You are advised to keep a record of your periods for both bleeding and pain symptoms (Menstrual Calendar- with modern technology there are a number of good “aps” you can use) so you can discuss them with your doctor at your follow up visit