Is endometrial ablation effective for treating vaginal bleeding due to menorrhagia (heavy menstrual bleeding)?

From the Guidelines

Endometrial ablation is a recommended treatment option for women with vaginal bleeding who have completed childbearing and have not responded to medical therapies. This procedure is used to treat abnormal uterine bleeding from various causes, including symptomatic submucosal myomas, and has a high success rate, with over 95% of patients reporting satisfaction 1. The procedure works by ablating the uterine cavity, which reduces or stops menstrual flow.

Key Considerations

• Candidates for endometrial ablation should have a normal-sized uterus with no significant fibroids, no endometrial hyperplasia or cancer, and no desire for future pregnancy, as the procedure makes pregnancy unlikely and potentially dangerous.
• The procedure typically takes 30-45 minutes and can be performed in an outpatient setting under local anesthesia with sedation.
• Recovery is relatively quick, with most women returning to normal activities within a few days.
• Success rates are high, with 80-90% of women experiencing significantly reduced bleeding and 30-50% achieving amenorrhea (complete cessation of periods).
• Side effects may include cramping, vaginal discharge, and occasional spotting during the first few weeks after the procedure.
• Endometrial ablation is not a form of contraception, so women should continue using birth control after the procedure.

Potential Risks and Complications

• Possible long-term complications of endometrial ablation include postablation Asherman syndrome, synechiae, cervical stenosis, contracture of the endometrium, strictures, endometrial distortion, and delayed endometrial cancer diagnosis 1.
• A study found a 23% failure rate in treating patients with submucosal fibroids, compared with a failure rate of 4% in patients with normal uterine cavities 1.

From the Research

Endometrial Ablation for Vaginal Bleeding

• Endometrial ablation is a safe and effective minimally invasive surgical procedure for treating abnormal uterine bleeding (AUB) of benign etiology 2.
• It is a well-established alternative to medical treatment or hysterectomy for select cases of AUB 2.
• The procedure can be performed using resectoscopic or non-resectoscopic techniques, both of which have low complication rates and high patient satisfaction 2.

Techniques and Technologies

• Resectoscopic endometrial ablation requires preoperative endometrial thinning, which results in higher short-term amenorrhea rates and shorter operative times 2.
• Non-resectoscopic techniques are technically easier to perform and allow for the use of local anesthesia, but may have higher rates of perioperative nausea and vomiting 2.
• The choice of technique depends on surgical judgment and the availability of resources 2.

Indications and Contraindications

• Endometrial ablation is indicated for women with AUB who have failed medical management and are seeking a minimally invasive treatment option 2, 3.
• Contraindications include pregnancy, active pelvic infection, and suspected or confirmed malignancy 2.
• Patients should be counseled about the need for permanent contraception following endometrial ablation 2.

Comparison with Other Treatments

• Endometrial ablation is as effective as the levonorgestrel-releasing intrauterine system for treating heavy menstrual bleeding 3, 4.
• Hysterectomy is a more definitive treatment option, but is associated with higher costs and surgical risks 4.
• Tranexamic acid is a medical treatment option that can reduce menstrual blood loss by 26%-60% and improve quality of life 5.