Endometrial ablation is generally designed to treat intractable cases of AUB, in which other modalities such as hormonal therapy, D and C, hysteroscopy, and removal of pathology have failed to correct the problem. In the majority of cases, a cause can usually be found and treated (such as hormonal dysfunction, endometrial polyps, uterine myomata, endometrial pathologies and adenomyosis).
Note: The procedure should not be done unless serious conditions such as uterine cancer have first been ruled out, and it is not appropriate in those individuals who still desire future fertility.
In the not too distant past, when standard diagnostic and therapeutic techniques failed in resolving AUB, hysterectomy was often the next step. Nowadays, endometrial ablation can offer an alternative to hysterectomy.
Below is a brief history of the medical advancements that led to endometrial ablation as it is know today:
- Electrosurgery and Freezing: The technique of using electrosurgery to destroy the endometrium and stop bleeding was originally developed in 1937, and using a probe to destroy the lining by freezing was introduced in 1967. Despite these early techniques, the idea did not become widely used until technological advances allowed visualization of the uterine cavity with hysteroscopy.
- The Hysteroscope: A hysteroscope is a fiber-optic surgical telescope, in which an operating channel passes through a dilated cervix, allowing the surgeon to examine and operate within the uterine cavity. The first of these instruments was introduced in 1981. Subsequently, the urologic resectoscope was utilized to destroy the lining by electrosurgical techniques of resection, vaporization, and roller ball electrode.
- Global Endometrial Ablation (GEA): The first of these devices was approved by the FDA in 1997, resolving the prior techniques’ inabilities to destroy every bit of endometrium (and subsequent higher failure rates). Advances in computer technology and the ease of instrumentation have increased the availability of these methods.
Currently, there are five FDA approved methods for global endometrial ablation:
- Heated Free Fluid: HydroThermAblater
- Radiofrequency Electricity: NovaSure System
- Thermal Balloon: ThermaChoice System
- Microwave energy: Microwave Endometrial Ablation System
- Cryotherapy: Her Option System
Each of these systems has advantages and disadvantages when compared to each other, but all achieve close to the same results. The decision of which system to use depends mostly on the comfort and experience of the surgeon with the device.
Global endometrial ablation for the treatment of intractable uterine bleeding in elect individuals offers an alternative to hysterectomy and represents a major advance in the field of gynecology.