Endometrial ablation or resection is a method of controlling menorrhagia (heavy periods) by destruction of the endometrium (lining of the uterus). It is performed by cauterising or removing the endometrium, leaving only myometrium (muscle) and fibrous tissue. When the endometrium sheds at the time of menstruation, a thin basal layer is left from which the endometrium regenerates during the next cycle. The aim of endometrial ablation is to remove this basal layer so that no regeneration occurs.

Hysteroscopic endometrial ablation by Nd: YAG, electrocautery resection (TCRE) or roller-ball electrocoagulation is a minimally invasive surgery useful in premenopausal women provided malignancy has been excluded.

Contraindications are

• Enlarged uterus, fibroid uterus, scarred uterus.
• Endometrial carcinoma, premalignant lesion.
• Young woman

Why is it Done?

Endometrial ablation is done to destroy most of the uterine lining. It is used to control heavy, prolonged menstrual bleeding when

• Bleeding has not responded to other treatments.
• Childbearing is completed.
• You prefer not to have a hysterectomy to control bleeding.
• Other medical problems prevent a hysterectomy

Suitability for Endometrial Ablation

It is an alternative to hysterectomy in many women with heavy periods, and is also of value in post-menopausal women who bleed heavily with hormone replacement therapy.

It is not suitable for patients who

• Have a very large uterus
• Have a uterus which contains large or multiple fibroids (benign growths arising from the uterine wall)
• Suffer marked pain with periods
• Wish to become pregnant at some time in the future
• Have cancerous or pre-cancerous change within the uterus

How Well It Works ?

Approximately 90% of women will have reduced menstrual flow following endometrial ablation, and up to half will stop having periods.

Younger women are less likely than older women to respond to endometrial ablation. After an endometrial ablation, younger women are more likely to continue to have periods and need a repeat procedure.

Conclusion

Endometrial ablation offers a high rate of cure for heavy periods without having to remove the uterus. The short hospital stay and rapid convalescence makes this an attractive alternative to hysterectomy if this procedure is suited to the patient.