ENDOMETRIAL ABLATION
Endometrial ablation is the surgical destruction of the uterine lining (endometrium). The endometrium must be destroyed to the level of the ‘basalis’, which is approximately 4 to 6 mm deep, depending upon the stage of the menstrual cycle.
OVERVIEW
Women with abnormal uterine bleeding have a variety of therapeutic options (see section on HEAVY MENSTRUAL BLEEDING). Endometrial ablation has become an increasingly popular treatment, since it is ‘minimally invasive’ and successful ablation avoids chronic use of medications.
Endometrial ablation is the surgical destruction of the uterine lining (endometrium). The endometrium must be destroyed to the level of the ‘basalis’, which is approximately 4 to 6 mm deep, depending upon the stage of the menstrual cycle.
This can be accomplished in the following 2 ways:
- RESECTOSCOPIC – under hysteroscopic visualisation (see section on HYSTEROSCOPY), specially designed instruments are used to destroy the endometrium. These techniques are also referred to as standard or first generation ablation.
- NON RESECTOSCOPIC – an ablation device, which is inserted into the uterine cavity, delivers energy to uniformly destroy the endometrium. They are also referred to as second or third generation ablation devices. A diagnostic hysteroscopy is usually performed prior to use of these devices and an endometrial biopsy taken if required.
The following are the different types of ablation devices currently available:
- Bipolar radiofrequency (NovaSure) – used by Mr de Rosnay
- Microwave
- Cryoablation
- Thermal balloon ablation
- Circulating hot water (hydrothermal)
Non-resectoscopic endometrial ablation techniques are more widely practiced than resectoscopic ablation, since they require less specialised training and often have a shorter operative time.
- However, ablation devices may not be appropriate in some cases. Traditional resectoscopic ablation may be more suitable if the shape or size of the uterine cavity will not accommodate an ablation device or if the patient has had multiple caesarean deliveries where ablation over the hysterectomy scar may be risky.
Examples of non-resectoscopic ablation devices
Note: Endometrial ablation is not appropriate for women with pre-cancerous changes to the endometrium (or cancer), or those who wish to preserve their fertility.
Endometrial ablation is not a recognised contraceptive technique. In fact, an alternative reliable form of contraception is strongly advised following this procedure as a future pregnancy may pose significant risks.
WHAT ARE THE RISKS OF ENDOMETRIAL ABLATION?
Please refer to the patient information leaflet below
WHAT CAN I EXPECT AFTER THE PROCEDURE?
Please refer to the patient information leaflet below
