TCRE/Rollerball ablation
Each month, the lining of the womb grows after your period and becomes gradually thicker. This lining also develops a very rich supply of blood, so, when it is shed with each subsequent period, the blood vessels within it also bleed. It is excessive bleeding from these blood vessels that is responsible for your current symptoms. TCRE is an operation which removes or burns much or all of the lining of the womb and seals the blood vessels responsible for excessive bleeding at the time of menstruation.
How is a TCRE performed?
At present, almost all TCRE’s are performed using general anaesthetic, although the procedure can be safely performed using a spinal or epidural anaesthetic.
TCRE is performed by passing a small telescope and operating instruments through the cervix into the womb cavity and burning the lining of the womb. Two different operations, or (more commonly) a combination of the two types of operation can be performed:
Trans Cervical Resection of the Endometrium (TCRE) is performed by removing the lining of the womb in strips by cutting it away using a small wire loop through which an electrical current is passed.
Rollerball ablation uses a similar electrical current to burn the lining of the womb without cutting it away, but by cauterising the lining of the womb to prevent it from growing back.
Because the operation is performed through the cervix and no incisions are made most cases can be performed as a day case, meaning that you have no overnight stay in hospital.
Do I need any treatment prior to my operation?
The doctor you see at the clinic will advise that between your clinic visit and admission for surgery you have some treatment to help reduce the heaviness of your periods before your admission. In addition to this, you will be asked to call with your general practitioner to collect a prescription for treatment to thin the lining of the womb prior to your admission. This has the effect of reducing the amount of tissue that has to be removed or burnt, makes the operation more easily performed and may result in a higher chance of a successful outcome from the procedure.
Two types of ‘pre-treatment’ are commonly used: a course of tablets called danazol and an injection known as a gonadotrophin releasing hormone agonist (GnRHa). Each of these treatments has a similar effect on the lining of the womb and side effects and about a quarter to one third of people will get mild side effects from the pre-treatment.
Common side effects are flushes, sweats, palpitations and dryness in the vagina, but these will all settle after you have completed your ‘pre-treatment.’
What are the chances of success and what happens then?
The aim of the operation is to reduce the heaviness of your periods rather than to stop them altogether, although some women will have no periods at all following TCRE.
30-40% will have no bleeding
50-60% will have lighter bleeding
10% of women do not get a benefit from TCRE
If you do not get a benefit from TCRE, or if you are not satisfied with the results, the doctor caring for you will discuss the alternative treatments available to you, although often a hysterectomy will be necessary to improve your bleeding pattern.
What should I expect following the procedure?
Most women are fit to be discharged from the hospital a few hours following their return to the ward. It is normal to feel crampy tummy pains, like period pain, and this may persist for a number of days following the procedure. This is often accompanied by the presence of a discharge as described above. It is advisable not to have intercourse or use tampons whilst the discharge is still present as the may increase the risk of developing infection. The doctor caring for you will arrange for you to be seen at the gynae clinic approximately 6 months following your treatment to assess your bleeding pattern.
You are advised NOT to become pregnant following endometrial ablation/resection so if you have any doubts about wanting children after the procedure you should not have it performed. The procedure is not contraceptive and you are advised that you will require some form of contraception to prevent a pregnancy occurring.
Registered Office: Malone Medical Chambers, 142 Malone Road, Belfast, BT9 5LH, NI
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