Endometrial ablation and HRT

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 the uterine lining remains.

How does endometrial ablation work?

The 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. About 10% of patients who undergo endometrial ablation find that their periods stop completely, and 70% 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.

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.

Taking HRT after endometrial ablation

HRT is a hormone treatment that includes the hormones estrogen, usually a progesterone (or progestogen), and for some testosterone as well.

As you still have your uterus (even if you’ve had an ablation and no longer have periods), you will also need to take a progesterone or progestogen, alongside the estrogen. This is known as ‘combined HRT.’ Taking estrogen alone can thicken the lining of the womb – which is still possible if any of the endometrium was left behind following your ablation. Over-thickening of the womb lining can increase the risk of uterine cancer, but taking a progesterone or progestogen alongside the estrogen keeps the lining thin and healthy and reverses this risk.

The type of progesterone with the least risks associated with it is called ‘micronised progesterone’ (branded as Utrogestan in the UK) and is body identical. This comes in the form of a capsule that you swallow, or some people prefer to use it vaginally. Another way of having a progestogen is to have a Mirena coil inserted into your uterus; this also acts as a contraceptive and needs to be replaced after five years. A third option for receiving progesterone is to take a tablet that combines body identical estrogen and progesterone in one, and this is branded as Bijuve® in the UK.

Combined HRT (estrogen and progesterone)

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 estrogen and progesterone every day and will prevent bleeding altogether.

If you’ve had an ablation and would like to take HRT, talk to your doctor or nurse, or see a specialist in the menopause to find out which type and dosage will best suit your needs.

Useful sources of Information:

Endometrial ablation

Heavy periods

Endometriosis

Balance related content:

https://www.balance-menopause.com/menopause-library/fibroids-and-the-menopause/

https://balance-menopause.com/uploads/2021/09/Endometriosis-and-HRT.pdf

https://www.balance-menopause.com/menopause-library/088-endometriosis-and-the-menopause-chris-mann-dr-louise-newson/

https://www.balance-menopause.com/menopause-library/surgical-menopause-and-menopause-in-women-with-endometriosis-video/