Hysteroscopic rollerball ablation

Read our guide below about your surgery and what to expect.

You can also download a PDF version of this patient information by following the link on the right.

What is an endometrial rollerball resection or ablation?

It’s the process where the lining of the womb (endometrium) is removed or destroyed. Removal of the endometrium is a successful treatment for women with heavy menstrual bleeding (HMB) who no longer want to have children.

Endometrial rollerball ablation or resection is an alternative treatment to:

• the Mirena intrauterine device
• endometrial ablation with Novasure
• a hysterectomy which is the traditional treatment for HMB.

What are the benefits?

With hysteroscopic surgery, the benefits include:

• significantly fewer complications
• no abdominal (tummy) cut
• day surgery with a much shorter hospital stay (about 4 hours)
• an overall shorter recovery period.

How do I know this operation is right for me?

If you have heavy or irregular periods, this operation is an option for you.

Because we treat the womb lining, we advise you not to get pregnant after resection or ablation so you should have completed your family and not want any more children.

The operation is particularly suited to you if you have heavy period bleeding but for personal or medical reasons, want to have a hysterectomy.

What investigations might I need before the operation?

Your gynaecologist will decide these with you.

These may include blood tests and possibly an ultrasound scan to detect if you have any fibroids in the womb. Or, they may advise you to have a hysteroscopy before the resection/ablation treatment.

A hysteroscopy allows us to assess the inside of your womb before surgery and estimate its shape and size. It also means we can take a small sample of the womb lining for a biopsy to confirm that there are no abnormal cells present.

We usually arrange the pre-treatment hysteroscopy as an outpatient procedure.

Will I need any treatment before the operation?

Occasionally, if your womb lining is particularly thick, your gynaecologist may prescribe a medication to thin the womb lining before endometrial rollerball ablation/resection.
This increases the chance of success of the procedure and will usually be a single injection of a drug called a GnRHa  at 4 to 6 weeks before surgery.

Side effects of GnRHa include:

• hot flushes
• night sweats
• headaches and
• your periods may stop.

These effects are all short-terms and will stop after about 6 weeks.

What does the surgery involve?

You’ll have an anaesthetic and the healthcare professional doing the surgery will pass an operating telescope into the womb via your cervix. They’ll gently stretch or dilate the cervix so they can pass the hysteroscope through the cervix into the womb.

Your surgeon will then connect the scope to a fluid system which allows a fluid saline to flow into the uterus via the scope and then back out of the scope through a suction channel.

Fluid will slightly expand the uterus to allow a clear view. The flow and suction technique means that your surgeon can closely monitor the amount of fluid used for the operation.

They’ll use a camera system connected to the scope to do the operation with the help of a monitor.

After your surgeon expands the uterus, they’ll pass an electrical current through a cutting loop attached to the scope and gently take the womb lining away. The electrical current in the cutting loop helps to ensure a cleaner cut and seals any blood vessels at the same time.

Alternatively, they may pass a current through a small metal ball and roll the ball over the womb lining. The the heat transfer from the ball destroys the womb lining.

We usually take still pictures before and after the operation so you can see the effects of the surgery.

The procedure takes about 30 minutes on average and you’ll usually get a dose of antibiotics.

After the procedure, the womb heals by scarring. Periods will generally be a lot lighter.

What happens after the operation?

You’ll have some vaginal bleeding and abdominal cramps after the operation but should be able to go home after a few hours.

What happens when I get home?

After we discharge you from the hospital, you may still have some abdominal cramps. You can take painkillers like paracetamol (panadol) or ibuprofen by following the manufacturer’s instructions.

You must rest for a few days, but can go back to work and start full activities again within 2 weeks.

Vaginal bleeding will reduce to a blood-stained discharge within around 2 weeks. The bleeding or discharge may last up to 3 to 4 weeks. To avoid an infection, you should not use any tampons or have sex during this time.

You may resume sexual activity once the bleeding or discharge stops.

Your first two periods after your operation may be heavy but by the third, you should notice a reduction in the amount of loss.

What are the possible risks and complications of hysteroscopic surgery?

There’s a small risk of complications from all hysteroscopic surgery.

As with other invasive operations on the womb, there’s a small risk of an infection of the uterus. You’ll notice an offensive vaginal discharge and will need antibiotics from your GP.

Occasionally the bleeding from the uterus may need controlling with the pressure of an inflated catheter inserted into the uterus. We can usually stop bleeding problems that happen during the operation for 2 to 4 hours after the operation. We’ll remove the catheter before we discharge you.

There’s a 1 to 2 in 1,000 operations of a perforation or small hole in the uterus. If this happens there’s a very small risk of bowel injury. If necessary, we may do a laparoscopy (putting a small telescope into the tummy) at the time of your operation to check this, and arrange any other necessary treatment.

As we use fluid to expand the uterus for the operation, excessive fluid absorption can happen in 1 to 5% of hysteroscopic resections. We can usually manage this by blood test monitoring
and injections that temporarily increase the passage of urine (diuretics). It may mean you’ll need to stay longer in hospital.

Despite these potential risks endometrial resection/ablation is usually a safe procedure.

If you experience other side effects

Call day surgery on 01494 526161. You can also speak to them about anything else related to your treatment.

How can I help reduce healthcare associated infections?

Infection prevention and control is important to the wellbeing of our patients so we have procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections.

You, and anyone visiting you, must use the hand sanitiser available at the entrance to every ward before coming in and after you leave. You may need to wash your hands at the sink using soap and water. Hand sanitisers are not suitable for dealing with patients who have symptoms of diarrhoea.

More help or advice

Contact our patient advice and liaison service (PALS) on 01296 316042 or bht.pals@nhs.net