Endometriumablation

Endometrial ablation is a medical procedure designed to destroy or remove the lining of the uterus (the endometrium) to reduce or stop heavy menstrual bleeding. It is typically offered to women who have completed childbearing or do not wish to become pregnant and for whom long-term medical therapy is ineffective or unsuitable.

The procedure is usually done on an outpatient basis under anesthesia. There are two main approaches: hysteroscopic endometrial ablation, which uses a hysteroscope to visualize the uterus and apply energy to the endometrium with various devices; and non-hysteroscopic or global endometrial ablation, which treats the endometrium without direct visualization, using energy delivered by a balloon or similar device.

Effectiveness varies, but many women experience a substantial reduction in bleeding or complete cessation for several years. It is not a guaranteed method of contraception, and pregnancy after ablation is possible but associated with high risk and is generally discouraged; if pregnancy occurs, management is complex.

Risks include uterine perforation, infection, bleeding, pelvic pain, and changes in menstrual patterns. Some patients continue to bleed or require repeat procedures or hysterectomy. The durability of results decreases over time for some women.

Preoperative assessment usually includes medical history, pelvic examination, ultrasound, and assessment to exclude cancer or hyperplasia. Suitable candidates have heavy bleeding without suspicion of cancer and have completed childbearing. Alternatives include medical therapies, the levonorgestrel intrauterine system, or hysterectomy.