Endometrial ablation and HRT

Understand your options after having an endometrial ablation for heavy, painful periods

Endometrial ablation is a surgical treatment most commonly used for treating heavy and painful periods. The procedure involves destroying or removing some of the lining of the uterus (womb). Following this treatment, your periods may become lighter or stop altogether, depending on how much of your uterine lining remains.

RELATED: Heavy periods during the perimenopause: what you need to know

How does endometrial ablation work?

Your uterus is made up of two layers: the outer layer is called the myometrium, and the inner lining is called the endometrium. During your menstrual cycle, each month the lining thickens in preparation for a fertilised egg. If conception doesn’t occur, the lining breaks down and is shed, this shedding of the lining is your period.

When this lining is reduced or removed through endometrial ablation, this will reduce (or even stop) menstrual blood loss. Many women who undergo endometrial ablation find that their periods stop completely, and the majority of women find that their periods become lighter. The effects are usually permanent, but some people find that heavy or painful periods can return, especially if they were under the age of 40 when they had the ablation treatment.

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How is endometrial ablation performed?

There are two main types of endometrial ablation, both of which can be performed under local or general anaesthetic:

• using heat – an electrical source, radio waves or lasers are used to destroy the uterine lining, via the vagina and cervix.
• using ultrasound energy – high levels of ultrasound energy from outside the body are used to destroy any fibroids, without damaging healthy womb lining.

Can I take HRT after endometrial ablation?

If you are experiencing perimenopausal or menopausal symptoms, HRT is usually the first-line treatment.

As you still have your uterus (even if you’ve had an ablation and are no longer have periods), you will need to take progesterone or progestogen, alongside oestrogen. This is known as ‘combined HRT.’

This is because taking oestrogen alone can thicken the lining of the womb – which is still possible if any of the endometrium was left behind following your ablation. Taking a progesterone or progestogen alongside the oestrogen keeps the lining thin and healthy.

The pattern in which you take the progesterone/progestogen determines whether or not you will have a monthly bleed:

Cyclical HRT

This involves taking progesterone for 10-14 days each month, resulting in a monthly bleed. This pattern is usually used if you have had a period within the last year.

Continuous combined HRT

This involves taking oestrogen and progesterone every day and will prevent bleeding altogether.

RELATED: Sequential and continuous HRT: what’s the difference?

Women who have had an ablation can still usually take testosterone.

If you’ve had an ablation and would like to take HRT, talk to your healthcare professional to see which type and dosage will best suit your needs.

Resources

Royal College of Obstetricians and Gynecologists, ‘Endometrial ablation – recovering well’