Intrauterine Ablation or Resection of the Endometrium

Ablation or destruction of the endometrium is used to treat menorrhagia in women who failed standard therapy. It is considered a less invasive alternative to hysterectomy; however, as with hysterectomy, the procedure is not recommended for women who wish to preserve their fertility.

Techniques for endometrial ablation are generally divided into two categories: those that do and do not require hysteroscopic procedures (also known as first- and second-generation procedures). Hysteroscopic techniques were developed first; the initial technique was photovaporization of the endometrium using an Nd-YAG laser, and this was followed by electrosurgical ablation using an electrical rollerball or electrical wire loop. (The latter technique is also known as transcervical resection of the endometrium or TCRE).
Hydrothermal ablation also involves hysteroscopy. Hysteroscopic techniques require skilled surgeons and, due to the requirement for cervical dilation, use of general or regional anesthesia. In addition, the need for the instillation of hypotonic distension media creates a risk of pulmonary edema and hyponatremia such that very accurate monitoring of fluids is required. Intrauterine ablation or resection may be performed on an outpatient basis, with an overnight hospital stay, or in a physician’s office depending on the method used.
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