Dr Jan Adlam

Gynaecologist and Urogynaecologist

Treatment

Endometrial ablation

Endometrial ablation is a minimally invasive procedure to reduce heavy menstrual bleeding by treating the lining of the uterus. It’s done through the cervix (no abdominal cuts). For many women, periods become much lighter and sometimes stop.

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A theatre-based approach

I most often perform ablation in theatre under a short general anaesthetic. This keeps you comfortable, allows precise technique, and makes it easy to combine the procedure with hysteroscopy when needed (so we confirm the cavity looks normal before treatment).

Common goal: less bleeding, better quality of life, and avoiding bigger surgery when it isn’t necessary.

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This page is general education. Your suitability depends on your bleeding pattern, scan findings, medical history, and future plans.

What is endometrial ablation?

Endometrial ablation treats heavy menstrual bleeding by reducing or destroying the uterine lining (endometrium). Because the lining is what sheds each month, treating it usually makes periods much lighter. In some women, periods stop completely.

Key point: Ablation is for heavy bleeding. It is not a fertility treatment, and it is not suitable if you want a future pregnancy.

Who is it for?

Ablation is most helpful for women with heavy periods that affect daily life, especially when medication hasn’t worked well or isn’t a good fit. It’s only considered for women who are finished with childbearing.

Often suitable

  • Heavy menstrual bleeding with a normal or small uterine cavity
  • Bleeding affecting work, sport, sleep, or quality of life
  • Iron deficiency or anaemia related to bleeding
  • Finished with childbearing

Not suitable

  • Desire for future pregnancy
  • Suspected or proven endometrial hyperplasia or cancer
  • Active pelvic infection
  • Some uterine cavity shapes/sizes depending on device and findings

How we decide

  • Your bleeding pattern and goals
  • Ultrasound findings (fibroids/polyps/adenomyosis clues)
  • Endometrial biopsy results
  • Whether Mirena / medication is a better first option

How it’s done (NovaSure in theatre)

I most often use the NovaSure radiofrequency system. The procedure is performed in theatre under a short general anaesthetic so you’re comfortable and completely still.

Step 1

Hysteroscopy check

A slim camera checks the uterine cavity so we know exactly what we’re treating (and we can address polyps if present).

Step 2

Ablation treatment

The NovaSure device conforms to the cavity and treats the lining (often around 90 seconds). No cuts, no stitches.

Step 3

Same-day discharge

Most women go home the same day. Cramping is common for 1–3 days and is usually manageable with simple pain relief.

Why theatre? Comfort, controlled conditions, and the ability to combine hysteroscopy with treatment when needed.

How this compares with other options

Heavy periods can be treated in several ways. Ablation sits between medication and hysterectomy: more effective than tablets for many women, far less invasive than removing the uterus.

Medication

  • Tranexamic acid or anti-inflammatories
  • Hormonal tablets or injections
  • Mirena IUD

Good first step, but some women still have troublesome bleeding or side effects.

Endometrial ablation (NovaSure)

  • Short theatre procedure
  • No abdominal incisions
  • Usually back to normal life within 1–2 days
  • Major reduction in bleeding for most women

Designed for women finished with childbearing who want effective control without major surgery.

Hysterectomy

  • Definitive solution for bleeding
  • Longer surgery and recovery
  • Appropriate when other treatments fail or anatomy demands it

Best option in some cases (for example large fibroids or complex disease), but not always necessary.

Bottom line: The “best” option depends on your diagnosis, scan findings, and goals. In consultation we match the treatment to your situation, not to a generic algorithm.

Before the procedure

Before ablation, we confirm it’s safe and appropriate. This usually includes an ultrasound assessment and an endometrial biopsy to exclude abnormal cells.

  • Pregnancy must be excluded
  • Ultrasound to assess the uterus (and look for fibroids/polyps)
  • Endometrial biopsy to rule out hyperplasia/cancer
  • In some cases, hysteroscopy first to confirm the cavity

Recovery & what to expect

Most women recover quickly. Mild cramping and watery/pink discharge are common for a short period.

  • Mild cramping for 1–3 days
  • Watery/pink discharge for up to ~2 weeks
  • Return to normal daily activities in 1–2 days
  • Periods may be irregular at first
  • Final bleeding pattern often settles over 8–12 weeks
  • Contact us if bleeding is heavy or pain is worsening
Post-op recovery guidance

What results are realistic?

The aim is improvement, not a guarantee of “no periods ever again.” Many women have a major reduction in bleeding; some stop having periods completely.

  • Most women notice a major improvement in bleeding
  • Some women stop having periods, but this can’t be guaranteed
  • A minority will need further treatment later (for example a repeat procedure or hysterectomy)

Important: If your main problem is pelvic pain (rather than bleeding), ablation may not address the root cause. We’ll clarify this before choosing treatment.

Risks & important limitations

Serious complications are uncommon, but every procedure has risks. The most important “risk” to understand is that ablation is not appropriate if you want a future pregnancy.

  • Cramping and short-term discharge (common)
  • Infection (uncommon)
  • Bleeding requiring review (uncommon)
  • Uterine perforation or injury (rare)
  • Thermal injury to surrounding structures (rare)
  • Bleeding may recur over time in a minority

Contraception matters: Ablation is not contraception. Pregnancy after ablation can be dangerous, so reliable contraception is essential if you are sexually active and not menopausal.

FAQ

FAQ

Will my periods stop?

Sometimes, but not always. The goal is a major improvement in bleeding. Some women stop having periods; others have much lighter periods.

FAQ

Can I still fall pregnant?

Yes, which is why contraception is important. Pregnancy after ablation can be dangerous for both mother and baby. If you want future pregnancy, ablation is not the right option.

FAQ

Is Mirena better?

Mirena is an excellent option for many women and is often tried first. If it’s not suitable, not tolerated, or doesn’t control bleeding well enough, ablation can be a strong next step.

FAQ

Is this better than hysterectomy?

It depends. Ablation is less invasive with a faster recovery, but hysterectomy is definitive. The right choice depends on your diagnosis and what you want to achieve.