90-second treatment for heavy periods leaves some women in agony – and needing a hysterectomy
Thousands of women every year have an endometrial ablation on the NHS.
It’s a treatment for heavy periods – and for a lot of women, the 90-second procedure brings relief from the sapping cycle of heavy bleeding.
But the procedure to destroy the womb lining fails in up to a fifth of cases, often leaving women with no treatment options left but a hysterectomy.
People whose ablations have failed describe debilitating, long-lasting pain that fractures mental health, relationships and careers – and doctors who seem to have little idea what’s wrong with them.
Karen Ramage knew immediately after her endometrial ablation in 2021 that something wasn’t right.
The pain only got worse. The month prior, she had run 100 miles. By two weeks after the procedure, she couldn’t walk properly. She couldn’t drive, she couldn’t work, she could barely eat. And she couldn’t find a doctor who would agree the endometrial ablation might be to blame.
“My personal belief is that they just don’t expect anything to go wrong,” she told Sky News.
The discussion of risks beforehand was limited to being warned of adhesions between the womb and bladder or bowel, she says. She was told the worst outcome would be no improvement in her bleeding.
But constant pain set in down her right side, intensifying to “labour-like contraction pains” around the time of her period.
As months passed, she relied on daily doses of Tramadol. Talking to a counsellor, she tried to reckon with how she could live like this: “I felt that everything had been taken away from me.”
Karen Ramage had to pay for a hysterectomy privately after her ablation failed
It took going private for a doctor to tell her definitively her ablation had failed.
“I was probably more relieved that actually somebody would believe in me, because it was this whole thing that nobody would believe that this procedure had caused all of this.”
Facing up to a two-year wait on the NHS for a hysterectomy, she took out a loan to cover the £7,500 cost of having it privately. After months not working, it was a tough financial call – one that meant relying on food banks.
How ablations work – and fail
About one in four women suffer from heavy periods and more than 30,000 women in England had an endometrial ablation on the NHS between 2017 and 2022.
Most were radiofrequency ablations, where electromagnetic energy is used to burn away the lining of the womb.
The womb lining is what grows and sheds each month so the idea is that no lining means no – or lighter – periods.
But if not all the lining is destroyed, it still grows and sheds – but scar tissue can mean the blood gets trapped. It builds up in pockets behind the tissue, sometimes behind a scarred-shut cervix, causing intense pain until it disperses back into the body.
In women who have been sterilised the blood can back up into the fallopian tubes – this is known as PATSS (post-ablation tubal sterilisation syndrome).
In cases of late-onset failure, the lining regrows in the months and years after an ablation.
Some women experience pain cyclically each month, while for others post-ablation pain is constant or just during sex.
Women who spoke to Sky News describe agony worse than labour. One woman would put herself in the recovery position when the pain started because she knew she would blackout. Another came close to losing her job because she needed drugs so strong they made her a “zombie”.
‘Ablation ruined 10 years of my life’
Amanda Connor was told an ablation would “solve all my problems”, but three years later her womb had “completely grown back”. She decided to try the procedure a second time in 2010.
The pattern of monthly pain only intensified over time. It would start in her feet, a tingling fiery burn. By the time it reached her legs, she would be doubled over. Then it raged through her abdomen.
“I couldn’t stand up, I was on the floor writhing about and screaming for hours,” she told Sky News.
Her husband could only watch for so long before he would call an ambulance – just like he did the month prior, and the one before that.
At the hospital they would do the same checks for appendicitis, then pelvic inflammatory disease. But Amanda was sure they were looking for the wrong thing: “It’s not pelvic inflammatory disease, it’s happening every single month.”
Reports of not being believed or “gaslighting” were common among women who spoke to Sky News. One was told her pain must be a bladder infection. Two women were told it was IBS.
Nobody told Amanda it could be a failed ablation. She was the one who brought it up with her gynaecologist.
A scan revealed her womb was a “lump of scar tissue”. The only way to fix it was to remove her womb entirely.
She was shocked when her doctor told her: “Not only have I been totally misled about ablation and how amazing it is – I am now facing a major operation in order to fix it.
“If I could go back I would never have it done.
“Ablation ruined about 10 years of my life. The effect on my marriage, my work life and home life was huge.”
Taking legal action
Experiences like this are familiar to Dr Victoria Handley, a lawyer specialising in gynaecological medical negligence cases.
She estimates she’s handled about 1,000 cases relating to endometrial ablation since 2015. Every week she will hear from one or two women who have had complications from ablations.
They report adhesions of the uterus to the bladder or bowel, perforation of the uterus, infertility they weren’t warned about and ultimately needing further surgery.
Women are going to the doctor with heavy periods and ending up needing a hysterectomy, “the most radical thing you can have”, Dr Handley says. A hysterectomy carries risks including incontinence, sexual dysfunction, prolapse and early menopause.
“You’re swapping one problem for another without realising that the problem you’re swapping is actually worse than the problem you’ve got,” she told Sky News.
Dr Victoria Handley says she has handled about 1,000 cases
Exactly how many women suffer post-ablation complications is hard to pinpoint as research tends to only capture patients who have resorted to further surgery.
A study of more than 110,000 women in England who had an endometrial ablation between 2000 and 2011 found 16.7% had further surgery within five years. Other studies put the number at more than 20%.
Up to one in five ablation patients may have abnormal bleeding or period pain, or both, according to Professor Justin Clark, consultant gynaecologist and spokesperson for the Royal College of Obstetricians and Gynaecologists.
NICE guidelines set out treatment pathways for heavy bleeding. This includes taking a patient’s full history, investigating the cause of the bleeding and exploring conservative options like the coil and pill before an ablation.
A spokesperson for NHS England told Sky News staff should be following this guidance and “should make clear the benefits and potential risks of any recommended treatment so patients can make informed decisions”.
But Dr Handley says in her experience, “a lot of what’s in this guideline is ignored by the medical profession because they’ll go, ‘oh, I know what’s wrong with you’, and I’ll go straight to the surgery, and they don’t actually carry out the investigation and then send them down the correct route”.
Medical negligence cases need to establish a breach of duty; for endometrial ablation this is normally failure to warn of the risk of complications or failure to offer alternatives.
The claimant needs to prove they were injured, and the injury was caused by the breach. They also need to be able to show logically that had they been informed of the risks or alternatives, they would not have gone ahead with the ablation. If those four things don’t align, the case will fail, Dr Handley says.
The majority of cases are settled by NHS trusts out of court, she says, and women tend to receive upwards of £20,000, depending on the injury they have suffered.
Despite the number of cases she has dealt with, she says she has seen no attempt to solve the issue.
“The NHS response is woeful. There’s no joined up thinking at all. There’s no recognition that there’s an overarching problem, and there’s no desire to fix it.”
NHS England and NHS Scotland did not address questions from Sky News about how they are responding to this at an organisation-wide level.
‘It makes me sick to know my womb is burned’
Emma Burchell says she does not believe the risks were discussed in full when she had an ablation – which she calls “the worst decision I ever made”.
“You trust these doctors to do the right thing for you, and then you feel like they’ve not,” she says.
The months since the procedure in May 2022 have been “horrendous”. Constant sharp pain through her back, stomach and legs drove her to the doctor again and again, but she says she wasn’t given pain relief.
Instead she was offered antidepressants. She declined, worried she would be told the pain was “all in her head” if she accepted.
Now she’s considering a hysterectomy. “Do I need my womb?” she questions. “It makes me sick to know my womb is all burned, and it’s sat inside my stomach.”
But getting more surgery isn’t a quick fix. Gynaecological waiting lists in England have more than doubled since the start of the pandemic.
Emma has been put on injections to create a chemical menopause, a process which can help diagnose the cause of gynaecological symptoms, before doctors will consider a hysterectomy. In the meantime, each day is a “battle”.
Emma Burchell says getting an ablation was the ‘worst decision’ she’s ever made
Unsuitable candidates for ablation
A number of factors make an ablation more likely to fail: a younger age, fibroids, previous C-sections, polyps, a retroverted uterus (where the womb tips backwards) and adenomyosis (where the womb lining grows in the muscle of the womb).
According to Professor Clark, “endometrial ablation works best for women above 40 years old with relatively normal sized wombs without significant fibroids”.
Studies stress the importance of making sure women are good candidates for the procedure. A medical device alert from the UK’s Medicines and Healthcare products Regulatory Agency said the same.
Still, Sky News spoke to women who between them had all the contraindications above and had been given an ablation.
Karen Ramage found out after her ablation that she had a retroverted uterus – increasing the chance of ablation failure sixfold – as well as fibroids.
Ablations can be done where women have small fibroids, but she was told in her case it was like trying to “wallpaper over air bubbles and lumps, so it doesn’t cover the whole surface”.
When ablations work
Endometrial ablation support groups have sprung up on Facebook; the largest has more than 14,000 members, mostly in the US.
Women share stories of nerve damage, sepsis, infections, bloating, continued heavy bleeding. It’s nerve wracking reading for people considering the procedure – or who had it done before finding the group.
Samantha Williams hovers in the group, popping up in the comments to share her experience and reassure people. She had an ablation after 18 months of non-stop bleeding and it made a “massive difference” to her quality of life. It stopped the bleeding and hasn’t caused pain.
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If you think of treatments for heavy bleeding as the alphabet, she says, a hysterectomy is Z. With her NHS gynaecologist they worked through until they got to Y, an ablation.
The risks were explained, the patient information leaflet was detailed and she was confident it was right for her.
Still, her advice is the same as women who had bad experiences: “Do your homework. But also try everything else first. It shouldn’t ever be the first thing that you do. There’s lots of other options.”
What the NHS says
Sky News contacted NHS England and Scotland, as well as the NHS trusts that treated Karen, Amanda and Emma.
NHS England said endometrial ablation is “one of a number of treatments” for heavy bleeding that is given “when clinically appropriate”.
“While most women do not experience significant pain after this procedure, we strongly encourage any woman with concerns to speak to their clinician or GP,” it said.
A Scottish government spokesperson said “person-centred care” was a priority and involved working in partnership with patients to understand what they need, and how their desired outcomes can be achieved.
“An essential component of this approach involves providing tailored, understandable information so that people are fully informed and involved in decision-making about their care as much as they choose.”
A spokesperson for Bolton NHS Foundation Trust said: “We welcome the opportunity to speak with any patient directly if they had concerns about their care or treatment, so we can fully understand their experience and make improvements where possible.”
NHS Forth Valley again said it followed guidelines and best practice, adding that treatment options may be discussed at multidisciplinary team meetings to identify the most suitable options.
Follow up investigations would be carried out where there is ongoing pain or other symptoms, which could identify unrelated medical conditions as the source of pain, the spokesperson said.
New details have been unveiled for Universal’s first UK theme park – including plans for the attraction to be open 365 days a year.
Universal Destinations & Experiences – which is owned by Sky’s parent company Comcast – has bought land near Bedford as it plans to build Europe’s largest theme park with millions of visitors per year, as well as a 500-room hotel and dining area.
Economic benefits
Universal’s economic impact analysis, produced in line with HM Treasury guidelines on economic appraisal and published today suggests the attraction will generate nearly £50bn of economic benefits for the UK.
It said the net economic contribution of the potential project for the UK was forecast to be £35.1bn over the construction period and first 20 years of operation.
Up to a further £14.1bn was expected to be generated in extra taxes for the exchequer over the same period.
The analysis suggests the project will generate 20,000 jobs during the construction period which, at its peak, will see 5,000 workers on the site.
Once operational, it is expected to create an initial 8,000 new jobs, rising over time. The company has made a commitment to pay the living wage to employees.
‘The best location we’ve ever seen’
Universal has acquired almost 500 acres for the site, which is just south of Bedford between Kempston, Wootton, Stewartby and Wixams, with an option to buy up to a further 200 acres.
A map showing the land Universal has purchased
The new park, which would have a construction period of around six years, would be built on land once occupied by Kempston Hardwick brickworks, once the world’s largest brickworks in terms of output, which closed in 2008 and which was demolished in September 2021.
“I can tell you it’s going to be a world-class park with all experiences that people will love based upon the most popular films, video games and stories that people have enjoyed for decades,” said Page Thompson, the company’s president in charge of new ventures.
“We’ve spent the last decade looking all over Europe and the United Kingdom for locations, and we think this is the best location we’ve ever seen.”
Universal Destinations & Experiences currently has five theme parks around the world – in the United States, Japan, China and Singapore.
Disneyland Paris, which with the associated Walt Disney Studios Park is currently Europe’s biggest theme park, attracts around 15 million visitors per year.
New details
“Our phase one plans consist of a theme park, a 500-room hotel and a dining area that people can come to even if they don’t have a theme park ticket,” Mr Thompson told Sky News.
“Over time, I would expect the number of hotels to grow.
“Our intention is that this park would be open 365 days a year, just like all of our other major theme parks.
“We have a whole series of special events, like our Halloween Horror Nights and carnival parties… and it just allows us to attract people throughout this time.”
Universal said evidence from its other theme parks suggested that for every job supported within the parks at least 1.5 further jobs could be supported in the supply chain and neighbouring parts of the economy – leading to its expectation of a net additional 20,000 jobs.
Plenty of competition
The investment is not without risks and not least because of its scale.
Of Europe’s 20 most visited theme parks, four – Legoland Windsor, Alton Towers, Chessington World of Adventures and Thorpe Park – are in the UK, all owned by the former FTSE-100 giant Merlin Entertainments. Their combined visitor numbers annually come to around half of what Universal is targeting.
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There is also plenty of competition.
Locally, not far from the proposed Bedfordshire site is the Harry Potter Experience at the Warner Bros studio tour near Watford, while there is Woburn Safari Park to the immediate north and Whipsnade Zoo to the immediate west of Luton.
There is no shortage of quality options for family days out. Further afield Europe already has more than 1,000 theme and amusement parks, many of them owned by Merlin, renowned for its astute management.
The weather issue
A third factor, potentially, is the weather. This is something that already handicaps a lot of theme parks in northern Europe, such as Liseberg in the Swedish city of Gothenburg, the Tivoli Gardens in the Danish capital Copenhagen and the original Legoland, in the Danish city of Billund, which close for some or all of the winter. So does Phantasialand, one of Germany’s biggest and most popular attractions.
Universal Destinations & Experiences, however, is thought to be undeterred by the English weather and points to the fact that the weather is not always perfect in other parts of the world in which it operates, most notably China and Japan.
The Paris experience
The company also appears undeterred by the experience of Disney in Paris.
The original Euro Disney was loss-making for many years – partly due to mismanagement and partly due to a misunderstanding of what European and particularly French consumers were looking for – and it has only really been since it was fully consumed by the Walt Disney Company, in 2017, that it has been effectively run.
Transport challenges
Another big risk is the transport links. Universal Destinations & Experiences – the name was changed last year from Universal Parks & Resorts to better reflect the kind of services customers will be offered in future in both the physical and virtual worlds – has selected the site primarily for its rail and road links to London and, with one in three visitors expected to come from overseas, for its proximity to Luton Airport.
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Yet those links are not currently up to handling the kind of visitor numbers Universal Destinations & Experiences is expecting.
The M1, the main road link to London, is frequently congested around the Luton turn-off at junction 10 and the road links from there to the site in need of improvement.
Accordingly, Universal Destinations & Experiences will be seeking government incentives to invest in local road and rail links.
Support could also come from East West Rail, the proposed new main line railway connecting East Anglia and South Wales, the first phase of which is a line between Oxford and Cambridge and for which a new station at Kempston Hardwick – whose existing station backs onto the land the park would operate – has been proposed.
The planning process
Riskiest of all, perhaps, is the planning process. Local businesses and MPs are supportive while both Jeremy Hunt, the Chancellor and Mark Harper, the Transport Secretary, have been briefed on the project. Planning proposals have been submitted and Universal Destinations & Experiences has held talks with Bedford Borough and Central Bedfordshire Councils.
However, Mr Thompson confirmed that Universal Destinations & Experiences is seeking planning permission via a so-called special development order – which would take the decision out of the hands of the local authorities and instead leave the final decision on planning consent with the Department for Levelling Up, Housing and Communities.
A roll of the dice
So this is a big roll of the dice by Universal Destinations & Experiences.
The investment – the first phase of which will be several billion pounds – will take many years to pay off while thrill-seekers should probably not expect the resort to be up and running much before the end of the decade.
However, starting with a blank sheet of paper as it opens its first European venue, Universal Destinations & Experiences has the opportunity to bring something genuinely new not just to the UK but to Europe.
The name change made by the business last year reflects the fact that, in future, the business expects to be offering branded entertainment, culinary, gaming and consumer product experiences that go a lot further than the traditional theme park and resort offerings.
There could even be experiences at the resort which have yet to be conceived. It could be quite the ride.
UK
Election 2024: I spent a week travelling on night buses to see a view of the UK politicians don’t
There is a rhythm to a night at the Bolton Interchange.
People dart from arriving buses, racing across the concourse to catch departing ones. Sometimes they do, sometimes they don’t. Each rush is followed by a brief lull.
Every night, hundreds of lives intersect at the Bolton Interchange. The night-shift workers and commuters, those out on the town and those just a little bit lost.
Each one has their own story, some are happy to chat, most lose themselves in whatever is playing through their headphones.
I spent a week on the night buses. With the election looming, what the politicians are experiencing on their campaign battle buses is not what ordinary people are seeing. Theirs is a very different perspective.
Sky News’s Greg Milam spoke to passengers on night buses
There is an unmistakeable despair about the state of the country, an indifference to what the political process might do about it and a dark humour about the future. There are very few flickers of optimism.
From the bus-spotter who says the country needs “a good clean”, to those who yearn for a Britain of a different age, to Pete, the elderly bluegrass guitarist heading for an open-mic night.
What does he think of Britain today? “Me and 50 mates are going to go to Lake Windermere to take a s*** in the water. We’ll see if they do anything to stop us, because they don’t seem to be stopping the water companies.”
It is just one of the many raw expressions of the frustration and hopelessness that I hear. As Carl, the night supervisor at the interchange, says: “Late shifts are different here. It is a real eye-opener.”
‘Vote? I just can’t be bothered’
With her shock of white hair and ankle-length peach quilted coat, Sophia Talbot is hard to miss as she jogs across the interchange concourse. She turned 80 a few weeks ago but is still working full-time. She is taking the 125 bus home after completing filming in Bolton as an extra on the TV drama, Waterloo Road.
Sophia: The country is a mess. When I first came to Bolton 21 years ago it was a really nice place and now it’s all run down and boarded up and I think that speaks for everywhere.
Every time I go to the supermarket, I seem to get less for my money. I can drive but I can’t afford a car so that’s why I take the bus.
I do the extras work for a bit of extra money. Extra extra money, I call it.
I don’t think I’ll last long enough to see things in this country change for the better. It will take a long time for that to happen because it has gone down too far.
I probably won’t even vote. I didn’t last time or the time before if I remember right. I just can’t be bothered, and I know that’s not good because if you don’t do it, you can’t blame anybody but yourself, can you?
‘I’m treated as third class, common muck’
It is just after 8pm, still light on this early summer evening, and Janey Fairhurst is passing through the interchange on her way from Bury to Wigan, after spending the day with a bereaved friend. She lost her job in medical research in November and, after 10 interviews, is still searching for work.
Janey: My life is drastically different to what it was. There are just not enough jobs. There are jobs down South but I feel the North gets forgotten about quite a lot when it comes to politics. Maybe they need to remember that we started the industrial revolution and they wouldn’t be here if it weren’t for that so maybe give the North some more funding and more jobs.
The empire is over, Britain has just crumbled, it has been going in the wrong direction for a long time and there’s no trust between the people and the politicians.
When I was in work I felt like I was winning. I could buy the Tropicana instead of Tesco’s own brand orange juice. You don’t really think about the politics of it all when you’ve got the money.
Now, I feel like I’m treated as third class, common muck and I’m not. I come from a good family. I feel frustrated, angry, sad, belittled, in a way – judged. I worked so hard to get where I was and now I can’t get back into it.
‘The cost of living has put a lot on people’
Three buses in the morning and three more in the evening are the routine of Saila Shabir’s working life. From her home in Great Lever to her job in Manchester, she says her time spent travelling has given her perspective on the value of community and the state of the country.
Saila: I think it wouldn’t do any harm for everyone to get on the night bus and experience life from this side of things. It might not be their cup of tea but it is a way to understand what people are saying and doing.
I find it uplifting travelling on the bus in the evening because you get to see people from all sorts of backgrounds. It is amazing, really, and it opens your mind that there’s huge prospects and a really expansive community that we could all bring together under one roof.
I’m not going to say I’m despairing but the cost of living has put a lot on people. People need to work together, we can’t just rely on one set of people to do it all. I am hopeful because I do trust the right people will do the job properly. I do see the darker side of life on the buses sometimes but you need the dark to see the light.
‘I have never known this country in such a state’
From his blue suede boots to his embroidered collar, Rick Conlon is dressed for a night on the town. It is 11pm and he is making his way home to Rochdale. At 6ft4in with a shaved head, it’s easy to see why he’s well known in local boxing circles. He is jovial despite despairing of Britain today.
Rick: I’m 58 and I’m not political particularly but I have never known this country in such a state. I just think it’s really tough at the moment. I know inflation has come down but there’s a lot of people far worse off than me struggling for food and the basic necessities.
We’re the fifth-richest country in the world, I find it incredible. When I was 16, 17, 18, in Margaret Thatcher’s time, 1981 and 1982, with all that political and social unrest, the country was still a better country. We had massive unemployment but the country was still a better country. People were looked after.
There’s that old saying about how you can judge a country by how it looks after its elderly. It’s just ridiculous how little they’re paid and how little they’re thought of.
If there’s one thing that makes me optimistic, bus fares make me optimistic. Two pounds – you can’t argue with that. Even then they’re probably subsidised but that’s great, because this is a great country, it’s just the government letting us down.
‘If it was up to me, I’d move country’
Muj Malik is travelling home with his partner Tabitha and five-month-old son, Zair, after another exhausting day searching for a new family home. They have faced months of frustration on growing council house waiting lists and, they say, see countless videos on TikTok from other young families in the same situation.
Muj: Things are not good in this country. My grandma moved here from Pakistan and my mum was born here so I’m third generation but, if it was up to me, I’d move country. I don’t want to live here for the rest of my life. I don’t see the point because the country is just going sideways.
At the end of the day, I’ve got a mixed-race baby, I grew up in a predominantly white area. I like the country and the people and I know there are people far worse off than us. But you’ve got war veterans from this country, people who have gone to war for this country, they’ve put their lives on the line, they’ve lost friends, and you’ve got them sitting outside of Asda homeless with no help whatsoever.
This country is fading miserably. I like the people, it’s not about the people, it’s about the way the country is run.
A man has been arrested as part of the police investigation into the Westminster honeytrap scandal.
The Metropolitan Police said they arrested a man in Islington, north London, on Wednesday morning on suspicion of harassment and offences under the Online Safety Act.
Multiple victims were informed by the police shortly afterwards.
Earlier this year, several men, working mostly in politics, said they had received unsolicited, flirtatious WhatsApp messages from people calling themselves “Charlie” or “Abi”.
Explicit images were exchanged in some instances.
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A Met Police spokesman said: “On Wednesday, 26 June, police executed a warrant at an address in Islington.
“A man was arrested on suspicion of harassment and committing offences under the Online Safety Act. He was taken into custody where he remains.
“The arrest relates to an investigation being carried out by the Met’s Parliamentary Liaison and Investigation Team following reports of unsolicited messages sent to MPs and others.
“The investigation remains ongoing.”
William Wragg stepped down from the Conservative Party when the scandal erupted in April after sharing other politicians’ personal numbers to someone he met on a dating app who threatened to release compromising information and pictures he had sent them.
Conservative Dr Luke Evans also revealed he was approached in March by two different numbers on WhatsApp “who purported to know me”.
He said he was the victim of cyber flashing and malicious communications “and blew the whistle by reporting it to the police and the parliamentary authorities as soon as this happened”.
This breaking news story is being updated and more details will be published shortly.
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