Howard T Sharp, MD
Tommaso Falcone, MD, FRCSC, FACOG
Sandy J Falk, MD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jun 2012. | This topic last updated: may 1, 2012.
INTRODUCTION — Women with abnormal uterine bleedinghave a variety of therapeutic options. Endometrial ablation has become an increasingly popular treatment, since it is minimally invasive and successful ablation avoids chronic use of medications. In a national study in England from 2003 to 2006, 60 percent of all surgical procedures performed for menorrhagia were endometrial ablations .
Endometrial ablation is the surgical destruction of theuterine lining. This can be accomplished under hysteroscopic visualization, using resectoscopic instruments to ablate or resect the endometrium. It can also be performed with a non-resectoscopic ablation device, which is inserted into the uterine cavity and delivers energy to uniformly destroy the uterine lining. Non-resectoscopic endometrial ablation techniques are more widely practiced thanresectoscopic ablation, since they require less specialized training and often have a shorter operative time . Endometrial ablation is not appropriate for women with endometrial hyperplasia or cancer, or those who wish to preserve their fertility.
This topic review will provide an overview of endometrial ablation. Techniques for non-resectoscopic endometrial ablation and resectoscopic endometrialablation or resection, as well as other management options for abnormal uterine bleeding, are discussed separately. (See "Endometrial ablation: Non-resectoscopic techniques" and "Endometrial ablation or resection: Resectoscopic techniques" and "Chronic menorrhagia or anovulatory uterine bleeding".)
TERMINOLOGY — Terminology used to describe endometrial ablation varies. In this topic review, thefollowing terms will be used:
* Endometrial ablation — Surgical destruction of the endometrium. The endometrium must be destroyed or resected to the level of the basalis (figure 1), which is approximately 4 to 6 mm deep, depending upon the stage of the menstrual cycle. In this topic review, endometrial ablation will refer to either non-resectoscopic ablation or resectoscopic ablation, orresection of the endometrium.
* Non-resectoscopic endometrial ablation — Endometrial ablation is performed with a disposable device which is inserted into the uterine cavity and delivers energy to uniformly destroy the uterine lining. Current non-resectoscopic technologies approved for use in the United States by the Food and Drug Association (FDA) are: bipolar radiofrequency (Novasure®); hot liquidfilled balloon (ThermaChoice®); cryotherapy (Her Option®); circulating hot water (Hydro ThermAblator®); and microwave (Microwave Endometrial Ablation). These techniques are also referred to as global or second generation ablation.
* Resectoscopic endometrial ablation — Endometrial ablation or resection performed under hysteroscopic visualization with resectoscopic electrosurgical instruments(eg, rollerball, wire loop, vaporizing electrode) or with laser. Endometrial resection is often referred to as transcervical resection of the endometrium. Resectoscopic ablation methods are also referred to as standard or first generation ablation. The term hysteroscopic ablation is also sometimes used for these methods; however, this designation would also include the circulating hot waternon-resectoscopic technique, since it involves instilling water through a hysteroscope.
Indications — The primary indication for endometrial ablation is treatment of ovulatory menorrhagia in premenopausal women. Ablation in women with anovulatory bleeding or postmenopausal women is discussed below (see 'Risk factors for endometrial cancer' below).
Ablation is usually used to treat...